支气管堵塞管行左下肺叶隔离对患者肺内分流及氧合作用的影响

目的 比较支气管堵塞管(BB)行左下肺叶隔离与左双腔支气管导管(DLT)行右单肺通气对肺功能正常患者肺内分流(Qs/Qt)和氧合作用影响的差异.方法 拟行左侧削胸下段食管手术患者36例,随机分成BB组和DLT组,每组各18例.丙泊酚靶控输注静脉诱导后,BB组插入ID8.0单腔气管导管,纤维支气管镜引导9FrCoopdech BB置入左下肺叶支气管,DLT组插入左DLT.两组均作双肺间歇正压通气,20 min后摆放有侧卧位,DLT组行右单肺通气,BB组对堵塞管套囊充气行右肺和左上肺叶通气.于双肺通气后20min(T1),右单肺通气或右肺和左上肺叶通气后20min(T2),开胸见左肺或左下肺叶完全萎陷后(T3),术毕拔出气管导管前(T4)抽取足背动脉血及右心房血进行血气分析,计算Qs/Qt.并请手术医生在开胸后即刻评价术野清晰度.术后第1天作动脉血气分析和胸片检查.结果 两组患者术野评价,各时点pH、PaCO_2、血红蛋白,T1的Qs/Qt、PaO_2、PO_2、氧合指数无统计学差异.在T_2～T_4时点,BB组的Qs/Qt低于DLT组,PaO_2、PO_2、氧合指数高于DLT组(P<0.05或0.01).BB组术后无肺不张病例,DLT组有2例发生左下肺不张.BB组术后第1天的PaO_2、氧合指数高于DLT组,术后住院天数比DLT组短(P<0.01).结论 支气管堵塞管行左下肺叶隔离能在左侧剖胸下段食管手术中减少患者的肺内分流、改善术中术后的氧合.

Abstract：

Objective To compare the differences in intrapulmonary shunt (Qs/Qt) and arterial oxygenation between selective left lower lobar blockade by Coopdech endobronchial blocker tubes (BB) and one lung ventilation (OLV) by left-sided double-lumen endobronchial tubes (DLT) in patients with normal pulmonary function. Methods Thirty-six patients (aged 32-64 years) scheduled for lower esophageal surgery were allocated randomly into BB and DLT groups (n=18). Anesthesia was induced and maintained with Propofol by target controlled infusion with intravenous administration of sufentanil and cisatracurium if needed. A 35 to 39 French tube was placed in the DLT group, and an 8.0-mm (internal diameter) single-lumen endotracheal tube was used in the BB group where a 9 French Coopdech BB was advanced into the left lower lobar bronchus guided by a fiberoptic bronchoscope. The variables recorded were blood gas analysis data from the venous and arterial blood samples at 20 min after two-lung ventilation in supine position (T_1), 20 min after initiation of one-lung ventilation or selective left lower lobar blockade by inflating BB balloons in the right lateral decubitus position (T_2), total collapse of the left lung or the left lower lobe after the pleura was opened (T_3), and before tracheal extubation (T_4). Qs/Qt was calculated using a standard formula based on the three-compartment model. Upon pleura opening, the effectiveness of lung collapse was evaluated by the surgeon who performed the surgery. Chest radiograph and arterial blood gas analyses were performed the day after the operation. Results Both of the groups were similar with regard to rank of the surgical exposure, pH, PaCO_2, hemoglobin from T_1 to T_4, Qs/Qt, PaO_2, PO_2, and oxygenation index at T1. In BB group, a significant reduction of Qs/Qt and greater improvements in PaO_2, PO_2, oxygenation index at T_2, T_3 and T_4 were observed in comparison with those in DLT group (P<0.05 or <0.01). No lobe collapse was observed postoperatively in BB group, but 2 patients in DLT group showed left lower lobe atelectasis. The patients in BB group showed better postoperative arterial oxygenation and shorter postoperative hospital stay (P<0.01). Conclusion Selective left lower lobar blockade by Coopdech endobronchial blocker tube during lower esophageal surgery provides a lower intraoperative intrapulmonary shunt and a better intra- and postoperative arterial oxygenation.

Effects of selective left lower lobar blockade by Coopdech endobronchial blocker tube on intrapulmonary shunt and arterial oxygenation: a comparison with double-lumen endobronchial tube

Objective To compare the differences in intrapulmonary shunt (Qs/Qt) and arterial oxygenation between selective left lower lobar blockade by Coopdech endobronchial blocker tubes (BB) and one lung ventilation (OLV) by left-sided double-lumen endobronchial tubes (DLT) in patients with normal pulmonary function. Methods Thirty-six patients (aged 32-64 years) scheduled for lower esophageal surgery were allocated randomly into BB and DLT groups (n=18). Anesthesia was induced and maintained with Propofol by target controlled infusion with intravenous administration of sufentanil and cisatracurium if needed. A 35 to 39 French tube was placed in the DLT group, and an 8.0-mm (internal diameter) single-lumen endotracheal tube was used in the BB group where a 9 French Coopdech BB was advanced into the left lower lobar bronchus guided by a fiberoptic bronchoscope. The variables recorded were blood gas analysis data from the venous and arterial blood samples at 20 min after two-lung ventilation in supine position (T_1), 20 min after initiation of one-lung ventilation or selective left lower lobar blockade by inflating BB balloons in the right lateral decubitus position (T_2), total collapse of the left lung or the left lower lobe after the pleura was opened (T_3), and before tracheal extubation (T_4). Qs/Qt was calculated using a standard formula based on the three-compartment model. Upon pleura opening, the effectiveness of lung collapse was evaluated by the surgeon who performed the surgery. Chest radiograph and arterial blood gas analyses were performed the day after the operation. Results Both of the groups were similar with regard to rank of the surgical exposure, pH, PaCO_2, hemoglobin from T_1 to T_4, Qs/Qt, PaO_2, PO_2, and oxygenation index at T1. In BB group, a significant reduction of Qs/Qt and greater improvements in PaO_2, PO_2, oxygenation index at T_2, T_3 and T_4 were observed in comparison with those in DLT group (P<0.05 or <0.01). No lobe collapse was observed postoperatively in BB group, but 2 patients in DLT group showed left lower lobe atelectasis. The patients in BB group showed better postoperative arterial oxygenation and shorter postoperative hospital stay (P<0.01). Conclusion Selective left lower lobar blockade by Coopdech endobronchial blocker tube during lower esophageal surgery provides a lower intraoperative intrapulmonary shunt and a better intra- and postoperative arterial oxygenation.