支气管堵塞器与双腔支气管导管在食管癌根治术中的应用对比研究

发布时间：2018-04-17 15:29

本文选题：单肺通气 + 支气管堵塞器　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:探讨支气管堵塞器与双腔支气管导管应用于食管癌根治术患者的临床应用效果比较。方法:选择于我院行择期食管癌根治手术治疗的60名食管癌患者,根据术中单肺通气方式,将其随机分为2组:支气管堵塞器组(BBs组)和双腔支气管导管组(DLT组)。所有患者经麻醉诱导后,BBs组先经口插入单腔气管导管,随后于纤维支气管镜引导下向相应侧别支气管内插入支气管堵塞器。DLT组经口插入双腔支气管导管,随后用纤维支气管镜调整其位置。术中、术后严格监测并记录以下指标:(1).记录患者一般情况(性别、年龄、身高、体重及ASA分级)、肺萎陷侧别、单肺通气时间。(2)术侧肺萎陷用时、单肺通气时气道阻力的大小、肺萎陷评分;(3)单肺通气结束后立即取桡动脉血进行血气分析,记录PH、PaO2、PaCO2、HCO3-、BE的结果;(4)ELISA法检测单肺通气结束前通气侧肺泡灌洗液中TNF-α、IL-6和IL-8的含量;(5)随访气管拔管后24h内声嘶、咽痛的发生情况和术后72h内肺部并发症的发生情况。结果:1.两组间患者一般情况、肺萎陷侧别、单肺通气时间无统计学差异(均为P0.05)。2.单肺通气时气道阻力BBs组明显低于DLT组(P0.05),而术侧肺萎陷用时BBs组较DLT组显著延长(P0.05),两组间肺萎陷评分差异无统计学意义(P0.05)。3.BBs组和DLT组间单肺通气结束即刻的动脉血气结果各项指标(PH、PaO2、PaCO2、HCO3-、BE)差异无统计学意义(均为P0.05)。4.单肺通气结束前,BBs组肺泡灌洗液中TNF-α、IL-6和IL-8的含量较DLT组显著下降(均为P0.05)。5.BBs组术后咽痛发生率显著低于DLT组(P0.05),而两组间术后声嘶和肺部并发症的发生率差异无统计学意义(均为P0.05)。结论:1.食管癌根治术中,支气管堵塞器与双腔支气管导管相比,具有气道阻力低、肺组织炎性因子影响小、术后咽痛发生率低的优势。而前者肺萎陷时间更长。2.支气管堵塞器与双腔支气管导管对术中动脉血气的影响、肺萎陷评分、术后声嘶和肺部并发症的发生率并无显著区别。
[Abstract]:Objective: to compare the clinical effects of bronchial occluder and double lumen bronchial catheter in radical resection of esophageal carcinoma.Methods: sixty patients with esophageal cancer undergoing radical resection of esophageal carcinoma were randomly divided into two groups: bronchial occluder group (BBs group) and double lumen bronchial catheter group (DLT group).After anesthesia induction, the BBs group first inserted a single lumen tracheal catheter through the mouth, and then, under the guidance of fiberbronchoscope, the bronchial occluder was inserted into the corresponding lateral bronchus. The DLT group inserted a double-lumen bronchial catheter through the mouth.The position was then adjusted with a fiberoptic bronchoscope.During and after operation, the following indexes were strictly monitored and recorded.The patients' general condition (sex, age, height, weight, ASA grade, lung collapse side, time of one-lung ventilation) were recorded.Lung atrophy score / 3) Radial artery blood was taken immediately after one-lung ventilation for blood gas analysis. The results of PHPao _ 2 and Paco _ 2H _ CO _ 3-OBE were recorded. The levels of TNF- 伪 IL-8 and TNF- 伪 IL-8 in pulmonary alveolar lavage fluid were detected by Elisa before the end of single lung ventilation). After tracheal extubation, there was hoarseness within 24 hours after tracheal extubation.The incidence of pharyngeal pain and pulmonary complications within 72 hours after operation.The result is 1: 1.There was no significant difference between the two groups in the general condition of the patients, the side of lung collapse, and the time of single lung ventilation (P0.05. 2. 2).The airway resistance in BBs group was significantly lower than that in DLT group (P 0.05), but the lung atrophy in BBs group was significantly longer than that in DLT group. There was no significant difference in pulmonary collapse score between the two groups (P 0.05). 3. Arterial blood at the end of one-lung ventilation in BBs group and DLT group.There was no significant difference in gas results between PHO 2 and Paco 2 (P 0 05. 4).The levels of TNF- 伪 IL-6 and IL-8 in alveolar lavage fluid in BBs group were significantly lower than those in DLT group (both the incidence of postoperative pharynx in P0.05).5.BBs group was significantly lower than that in DLT group (P 0.05), but there was no significant difference between the two groups in the incidence of hoarseness and pulmonary complications (both P0.05).Conclusion 1.In radical resection of esophageal cancer, the bronchial occluder has the advantages of lower airway resistance, less influence of pulmonary inflammatory factors and lower incidence of pharynx pain after operation compared with double-lumen bronchial catheter.And the former lung collapse time is longer. 2.There was no significant difference between bronchial occluder and double lumen bronchial catheter on arterial blood gas, pulmonary atrophy score, hoarseness after operation and incidence of pulmonary complications.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614;R735.1

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