Lin Zixin,Hu Jing,Liu Heqi,et al.Comparison of laryngeal mask airway combined with bronchial blocker versus endotracheal tube combined with bronchial blocker in pediatric thoracoscopic surgery[J].Journal of Clinical Pediatric Surgery,2026,(09):888-893.[doi:10.3760/cma.j.cn101785-202410024]
喉罩联合封堵器与气管导管联合封堵器在儿童胸腔镜手术中的比较
- Title:
- Comparison of laryngeal mask airway combined with bronchial blocker versus endotracheal tube combined with bronchial blocker in pediatric thoracoscopic surgery
- 摘要:
- 目的 探讨喉罩联合支气管封堵器相比气管导管联合支气管封堵器，是否更能提供优越气道管理策略。方法 本研究为前瞻性随机对照研究，纳入2023年11月至2024年8月于首都医科大学附属北京儿童医院行择期胸腔镜下纵隔肿物切除术的43例患儿作为研究对象，随机分为喉罩联合支气管封堵器组（L组）与气管导管联合支气管封堵器（T组）。记录两组患儿通气装置放置后10 min（T1）、单肺通气30 min（T2）、恢复双肺通气10 min（T3）时的气道峰压（peak airway pressure,Ppaw）、呼气末二氧化碳分压(end-tidal carbon dioxide partial pressure,PetCO2)，并计算氧合指数（oxygenation index,OI）和动脉-呼气末二氧化碳分压差（P(a-et)CO2）；术后喉损伤发生率（拔管即刻和术后第一天声音嘶哑发生率）。结果 按不同分组方式比较，L组和T组在T1时OI值[(546.8±12.9)mmHg和(524.6±10.4)mmHg]、P(a-et)CO2值[(8.4±1.7)mmHg和(9.9±1.3)mmHg]，Ppaw值[(13.7±1.1)cmH2O和(15.5±1.4)cmH2O]；两组在T2时OI值[(167.3±3.2)mmHg和(205.7± 2.7)mmHg]、P(a-et)CO2值[(15.7±3.7)mmHg和(12.8±2.3)mmHg]，Ppaw值[(27.7±4.7)cmH2O和(21.4±2.9)cmH2O]；两组在T3时OI值[(355.3±7.7)mmHg和(379.4±7.3)mmHg]、P(a-et)CO2值[(14.0±2.9)mmHg和(11.0±2.4)mmHg]；术后即刻两组的声音嘶哑发生例数（1例和7例），术后一天声音嘶哑发生例数（0例和4例）差异均有统计学意义(P＜0.05)。两组在T3时Ppaw值[(15.8±1.3)cmH2O和(16.3± 1.1)cmH2O]、T1~T3时PetCO2值[(36.7±4.2)mmHg和(36.7±4.6)mmHg、(47.4±11.2)mmHg和(42.5±7.0)mmHg、(38.2±6.0)mmHg和(35.4±5.6)mmHg]差异均无统计学意义(P＞0.05)。结论 在儿童胸腔镜手术中，喉罩联合支气管封堵器能够有效降低术后声音嘶哑的发生率；但随着单肺时间的延长，喉罩可能对患儿的肺功能产生不良影响，因此仅推荐在短小胸腔镜手术中考虑选用喉罩联合支气管封堵器对患儿进行单肺通气管理。
- Abstract:
- Objective This study aimed to investigate whether a laryngeal mask airway combined with a bronchial blocker provides a superior airway management strategy compared with an endotracheal tube combined with a bronchial blocker.Methods This was a prospective randomized controlled trial.A total of 43 pediatric patients who underwent elective thoracoscopic mediastinal tumor resection at Beijing Children’s Hospital,Capital Medical University,between November 2023 and August 2024 were enrolled.Patients were randomly assigned to:laryngeal mask airway combined with bronchial blocker group (Group L),and endotracheal tube combined with bronchial blocker group (Group T).Peak airway pressure (Ppaw) and end-tidal carbon dioxide partial pressure (PetCO2) were recorded at:10 minutes after airway device placement (T1),30 minutes after initiation of one-lung ventilation (T2),and 10 minutes after resumption of two-lung ventilation (T3).The oxygenation index (OI) and arterial-to-end-tidal carbon dioxide partial pressure difference (P(a-et)CO2) were calculated.Postoperative laryngeal injury was assessed by the incidence of hoarseness immediately after extubation and on postoperative day 1.Results At T1,Group L showed higher OI[(546.8±12.9) mmHg vs.(524.6±10.4) mmHg],lower P(a-et)CO2[(8.4±1.7) mmHg vs.(9.9±1.3) mmHg],and lower Ppaw[(13.7±1.1) cmH2O vs.(15.5±1.4) cmH2O]compared with Group T (all P<0.05).At T2,Group L had lower OI[(167.3±3.2) mmHg vs.(205.7±2.7) mmHg],higher P(a-et)CO2[(15.7± 3.7) mmHg vs.(12.8± 2.3) mmHg],and higher Ppaw[(27.7±4.7) cmH2O vs.(21.4±2.9) cmH2O](all P<0.05).At T3,Group L had lower OI[(355.3±7.7) mmHg vs.(379.4±7.3) mmHg]and higher P(a-et)CO2[(14.0± 2.9) mmHg vs.(11.0±2.4) mmHg](all P<0.05).The incidence of hoarseness was significantly lower in Group L both immediately after extubation (1 vs.7 cases) and on postoperative day 1 (0 vs.4 cases) (P< 0.05).There were no significant differences between the two groups in Ppaw at T3[(15.8±1.3) cmH2O vs.(16.3±1.1) cmH2O]or in PetCO2 at T1-T3[(36.7±4.2) mmHg vs.(36.7±4.6) mmHg,(47.4± 11.2) mmHg vs.(42.5±7.0) mmHg,(38.2±6.0) mmHg vs.(35.4±5.6) mmHg](all P>0.05).Conclusions In pediatric thoracoscopic surgery,the use of a laryngeal mask airway combined with a bronchial blocker can effectively reduce the incidence of hoarseness.However,with prolonged one-lung ventilation,the laryngeal mask airway may adversely affect pulmonary function.Therefore,this technique is recommended primarily for short-duration thoracoscopic procedures.
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备注/Memo
收稿日期:2024-10-12。
通讯作者:张建敏,Email:zjm428@sina.com