单腔气管导管在食道癌根治术单肺通气的临床评价

目的重新评价纤维支气管镜（Fiberoptic Bronchoscope,FOB）引导下单腔气管导管（Single-lumen endotracheal tube,SLT）在食道癌根治术中的作用及效果。方法在107例实施开胸食道癌根治手术的全麻单肺通气（OLV）患者中选择实施SLT行OLV的患者12例为A组,计算机随机抽取同期另一组麻醉医生实施的双腔气管导管（Double lumen endobronchial tube,DLT）管理下的患者12例为B组,分析并统计以下指标：①患者的人口学资料及A组使用SLT行OLV原因,术前肺功能指标。②气管导管指标：导管型号,置入深度。③OLV时间,OLV期（稳定后10min）通气肺Ppeak＆PETCO2,术后入ICU血气指标。④气管插管相关并发症：口齿损伤,气管及导管染血（插管后FOB观察）,咽喉疼。结果 A组3例超过3次试插DLT失败后,改为SLT置入右侧支气管,余9例皆一开始即置入SLT,或者调整体位右侧卧位后置入。OLV期指标及气管插管相关并发症两组无统计学差异（P〉0.05）。术后ICU血气指标皆在正常范围。结论在纤维支气管镜的引导下进行单腔气管导管插管,对于无严重并存疾患的食道癌根治术患者是安全可行的。

Clinical re-evaluation of using single-lumen endobronchial tube during one-lung ventilation in patients undergoing esophageal cancer resection

Objective To retrospective analyze fiberoptic bronchoscopy(FOB)-guided single-lumen endotracheal tube(SLT)in the use of surgery of esophageal cancer.Methods 107 cases of thoracic esophageal cancer radical surgery with one-lung ventilation(OLV) anesthesia of medical records system were implemented between 2010-2011 period.Using of the SLTs of 12 patients among them were defined as A group,the computer randomly selected 12 patients managed by another group of anesthesiologists at the same period with DLT(B group).Statistical analysis: ① demographic data of patients and the cause of using SLT during OLT in group A,preoperative pulmonary function.② endotracheal tube indicators: tube type,insertion depth.③ the time of OLT,the period of OLT(stable after 10min) ventilation lung’s Ppeak & PETCO2,postoperative blood gas into the ICU.④intubation-related complications: intraoperative awareness,oral dental injuries,tracheal and endotracheal tubes were blood-stained(FOB observed after intubation),sore throat.Results The three cases of A group were attempts more than three times after a failed intubated DLT,change to applying SLT into the right bronchus,in which 1 case was FOB guided by bronchial blocking devices;one case was left bronchial stenosis,35F L-DLT was put into 27cm,then always rebound,the FOB from the main tracheal tube of DLT look into and found that the blue bronchial cuff left stranded in the left bronchial opening,the small one type DLT(28F,Mallinckrodt) was not prepared,had to change the SLT into the right bronchial side;one case of abnormal left bronchial openings,located on the carina above 1cm,SLT was sent into the right bronchus successfully.Other 7 cases were placed in the beginning using the SLTs,or implantated after adjusting the right lateral position.The parameters of period of OLT and complications of intubation-related in both groups had no significant difference(P>0.05).All values of blood analysis in ICU were normal and acceptable.Conclusion Using single-lumen endotracheal tube under the guidance of fiberoptic bronchoscopy bronchus intubation maybe safe and feasible for the patients without serious co-exist disorders with esophageal cancer resection.