可視雙腔支氣管導管在肺隔離技術中的應用價值

呂磊　王治　劉秀文

[摘要]目的 探討可視雙腔支氣管導管在肺隔離技術中的應用價值。方法 選擇2016年10月～2017年2月在我院治療的胸腔鏡輔助下行單肺通氣的60例患者為研究對象，采用隨機數字表法分為纖維支氣管鏡組（F組）和可視雙腔支氣管導管組（VD組），每組30例。F組患者采用普通雙腔支氣管導管借助纖維支氣管鏡進行定位，VD組采用可視雙腔支氣管導管進行定位。記錄F組和VD組的導管定位時間、術中導管移位次數、導管移位致不良事件發生次數（手術側肺萎陷不佳影響術野、健側肺通氣不足、肺不張等）、導管移位后重新調整定位時間。結果 VD組定位時間短于F組（P<0.05）；兩組患者變動體位后導管移位發生率差異無統計學意義（P>0.05）；導管移位后發生肺萎陷不佳影響術野、肺通氣不足、肺不張等并發癥，VD組不良事件發生率低于F組，差異有統計學意義（P<0.05），VD組導管移位后重新調整定位時間明顯短于F組，差異有統計學意義（P<0.05）。結論 可視雙腔支氣管導管在導管定位、持續監測方面較纖維支氣管鏡有優勢，在肺隔離技術有很好的應用前景。

[關鍵詞]可視雙腔支氣管導管；肺隔離； 胸科手術

[中圖分類號] R614 [文獻標識碼] A [文章編號] 1674-4721（2018）2（c）-0028-03

[Abstract]Objective To explore the application value of visual double-lumen bronchial catheter in pulmonary isolation.Methods 60 patients with one lung ventilation assisted by video-assisted thoracoscopic surgery who were treated in our hospital from October 2016 to February 2017 were selected as subjects.They were randomly divided into fiberoptic bronchoscopy group（group F） and visual double lumen bronchial catheter group （group VD），with 30 cases in each group.Patients in group F were positioned with the help of fiberoptic bronchoscopy，and patients in group VD were positioned with the help of visible double lumen bronchial catheter.The catheter positioning time，the number of catheter displacement during operation，the number of adverse events caused by catheter displacement in group F and VD were recorded （poor collapse of the lung on the operation side affected the operation field，insufficient ventilation on the healthy side，atelectasis，etc.），and the positioning time was readjusted after catheter displacement.Results The localization time of group VD was shorter than that of group F，there was no significant difference between the two groups（P<0.05）.The incidence of adverse events in group VD was lower than that in group F （P<0.05）.The repositioning time of group VD after catheter displacement was significantly shorter than that in group F，the differents was satistically significant （P<0.05）.Conclusion The visual double-lumen bronchial catheter is superior to the fiberbronchoscope in the catheter positioning and continuous monitoring.It has a good application prospect in the lung isolation technology.

[Key words]Visual double-lumen bronchial catheter；Pulmonary isolation；Thoracic surgery

隨著胸外科手術的不斷進展，電視胸腔鏡手術（video assisted thoracoscopic surgery，VATS）成為今年來在臨床中普遍應用的一種胸部微創手術，該手術對于單肺通氣質量有很高的要求，需要有良好的肺隔離技術。臨床上常用的雙腔支氣管導管定位的方法主要有聽診法、回退法[1]、體表標志及阻力變化定位法[2-3]、呼氣末二氧化碳分壓與吸氣分壓監測法[4-5] 、纖維支氣管鏡（fiberoptic bronchoscope，FOB）法等，FOB自1986年后逐步應用于雙腔支氣管導管的定位，是目前臨床采用最多、最可靠的定位方法[6-9]，然而由于其不能進行持續監測，在肺隔離技術定位方面還有待創新。近年來，隨著超聲技術的發展與普及，超聲技術應用于胸科手術中在雙腔支氣管導管定位方面具有無創、定位準確、成功率高等優點[10]，同時可以通過測量氣管外徑來預測雙腔導管型號[11]，然而在術中持續監測、價格等方面與FOB相比并沒有優勢，限制了其在臨床中作為常規應用于導管定位，而可視雙腔支氣管導管的問世正好彌補了這些缺陷。本文通過與纖支鏡對比，評價可視雙腔支氣管導管用于肺隔離技術的效果，現報道如下。