Sun Lan,Zhang Jianmin,Cui Xiaohuan,et al.Comparison of two placement methods of Arndt endobronchial blocker in pediatric patients undergoing thoracic surgery[J].Journal of Clinical Pediatric Surgery,2020,19(10):935-938.[doi:10.3969/j.issn.1671-6353.2020.10.014]
Arndt支气管内阻断器的两种放置方法在小儿胸科手术中的对比研究
- Title:
- Comparison of two placement methods of Arndt endobronchial blocker in pediatric patients undergoing thoracic surgery
- Keywords:
- Intubation; Intratracheal; Thoracic Surgical Procedures; Child
- 分类号:
- R655;R616.5
- 摘要:
- 目的 通过对比小儿单肺通气实施过程中气管导管内外放置Arndt支气管内阻断器（Arndt endobronchial blocker，AEB）的相关指标，为选择更优的放置方法提供依据。方法 选择择期行胸科手术的患儿60例，其中男童31例，女童29例，年龄3~8岁，ASA Ⅰ或Ⅱ级，随机分为管内放置5F-AEB （管内组）及管外放置5F-AEB （管外组），每组30例。两组患儿在常规麻醉诱导后行气管插管及AEB置入。记录患儿单肺通气前后PETCO2及气道峰压力（peak airway pressure，Ppeak）变化，记录插管时间、纤维支气管镜定位时间、术中肺萎陷程度评分，术中AEB脱落情况以及术中缺氧情况，观察术后24 h受试者声音嘶哑及咽喉痛情况。结果 与单肺通气前比较，单肺通气后两组患儿PETCO2和Ppeak均明显增高（P<0.05）；与管内组比较，单肺通气后，管外组Ppeak值较管内组升高幅度小（t=4.944，P<0.05）。管外组插管时间和纤维支气管镜定位时间比管内组用时短（P<0.05）；两组患儿肺萎陷程度无统计学差异（P>0.05）。结论 与管内放置AEB相比，管外放置AEB在小儿胸科手术实施单肺通气过程中对患儿呼吸影响更小，且更容易通过纤维支气管镜定位。
- Abstract:
- Objective To compare the efficiency of intraluminal versus extraluminal approach on placing 5 French Arndt endobronchial blocker (AEB) during one-lung ventilation and seek an optimal placement method of AEB in pediatric thoracic patients.Methods Sixty children aged 3-8 years scheduled for thoracic operations were randomized into two groups of intraluminal placement of 5F AEB (intraluminal,n=30) and extraluminal placement of 5F AEB (extraluminal,n=30).Two groups received endotracheal intubation and AEB implantation after anesthesia induction.The durations for endotracheal tube and AEB placement and time for fiber bronchoscope position were recorded.The relevant perioperative parameters were measured including end-tidal carbon dioxide partial pressure (PETCO2) and peak airway pressure (Ppeak) during two/one-lung ventilation.Intraoperative lung collapsed score,endobronchial exfoliation and hypoxia were recorded and the frequency of postoperative hoarseness was observed.Results PETCO2 and Ppeak were significantly higher in both groups during one-lung ventilation than that during double-lung ventilation (P<0.05).Ppeak of intraluminal group was significantly higher than that of extraluminal group during one-lung ventilation (P<0.05).The durations for AEB placement and fiber bronchoscope position were shorter in extraluminal group than those in intraluminal group (P<0.05).Conclusion As compared with intraluminal approach,extraluminal approach has less adverse impact on ventilatiory parameters and it is easier to locate by fiberoptic bronchoscopy.
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备注/Memo
收稿日期:2019-09-20。
通讯作者:张建敏,Email:zjm428@sina.com