呂磊　王治　劉秀文

[摘要]目的 探討可視雙腔支氣管導(dǎo)管在肺隔離技術(shù)中的應(yīng)用價(jià)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(duì)象，采用隨機(jī)數(shù)字表法分為纖維支氣管鏡組（F組）和可視雙腔支氣管導(dǎo)管組（VD組），每組30例。F組患者采用普通雙腔支氣管導(dǎo)管借助纖維支氣管鏡進(jìn)行定位，VD組采用可視雙腔支氣管導(dǎo)管進(jìn)行定位。記錄F組和VD組的導(dǎo)管定位時(shí)間、術(shù)中導(dǎo)管移位次數(shù)、導(dǎo)管移位致不良事件發(fā)生次數(shù)（手術(shù)側(cè)肺萎陷不佳影響術(shù)野、健側(cè)肺通氣不足、肺不張等）、導(dǎo)管移位后重新調(diào)整定位時(shí)間。結(jié)果 VD組定位時(shí)間短于F組（P<0.05）；兩組患者變動(dòng)體位后導(dǎo)管移位發(fā)生率差異無統(tǒng)計(jì)學(xué)意義（P>0.05）；導(dǎo)管移位后發(fā)生肺萎陷不佳影響術(shù)野、肺通氣不足、肺不張等并發(fā)癥，VD組不良事件發(fā)生率低于F組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05），VD組導(dǎo)管移位后重新調(diào)整定位時(shí)間明顯短于F組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 可視雙腔支氣管導(dǎo)管在導(dǎo)管定位、持續(xù)監(jiān)測(cè)方面較纖維支氣管鏡有優(yōu)勢(shì)，在肺隔離技術(shù)有很好的應(yīng)用前景。

[關(guān)鍵詞]可視雙腔支氣管導(dǎo)管；肺隔離； 胸科手術(shù)

[中圖分類號(hào)] R614 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 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(shù)的不斷進(jìn)展，電視胸腔鏡手術(shù)（video assisted thoracoscopic surgery，VATS）成為今年來在臨床中普遍應(yīng)用的一種胸部微創(chuàng)手術(shù)，該手術(shù)對(duì)于單肺通氣質(zhì)量有很高的要求，需要有良好的肺隔離技術(shù)。臨床上常用的雙腔支氣管導(dǎo)管定位的方法主要有聽診法、回退法[1]、體表標(biāo)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(jiān)測(cè)法[4-5] 、纖維支氣管鏡（fiberoptic bronchoscope，F(xiàn)OB）法等，F(xiàn)OB自1986年后逐步應(yīng)用于雙腔支氣管導(dǎo)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(jìn)行持續(xù)監(jiān)測(cè)，在肺隔離技術(shù)定位方面還有待創(chuàng)新。近年來，隨著超聲技術(shù)的發(fā)展與普及，超聲技術(shù)應(yīng)用于胸科手術(shù)中在雙腔支氣管導(dǎo)管定位方面具有無創(chuàng)、定位準(zhǔn)確、成功率高等優(yōu)點(diǎn)[10]，同時(shí)可以通過測(cè)量氣管外徑來預(yù)測(cè)雙腔導(dǎo)管型號(hào)[11]，然而在術(shù)中持續(xù)監(jiān)測(cè)、價(jià)格等方面與FOB相比并沒有優(yōu)勢(shì)，限制了其在臨床中作為常規(guī)應(yīng)用于導(dǎo)管定位，而可視雙腔支氣管導(dǎo)管的問世正好彌補(bǔ)了這些缺陷。本文通過與纖支鏡對(duì)比，評(píng)價(jià)可視雙腔支氣管導(dǎo)管用于肺隔離技術(shù)的效果，現(xiàn)報(bào)道如下。