文章摘要
喉罩联合支气管封堵器对胸腔镜肺部分切除术患者术后肺功能的影响
Effect of laryngeal mask combined with bronchial blocker on postoperative pulmonary function in thoracoscopic partial lobectomy
  
DOI：10.12089/jca.2025.05.010
中文关键词: 喉罩  支气管封堵器  肺超声  炎性因子  术后肺部并发症
英文关键词: Laryngeal mask  Bronchial blocker  Lung ultrasound  Inflammatory factors  Postoperative pulmonary complications
基金项目:承德市应用技术研究与开发暨可持续发展议程创新示范区专项科技计划项目（202305B078）
作者单位E-mail
王莉萍 067000,河北省承德市,承德市中心医院麻醉科  
孙艳斌 067000,河北省承德市,承德市中心医院麻醉科 sun0403＠163.com 
关森 067000,河北省承德市,承德市中心医院麻醉科  
赵振儒 067000,河北省承德市,承德市中心医院麻醉科  
边晶 067000,河北省承德市,承德市中心医院麻醉科  
王曌 067000,河北省承德市,承德市中心医院麻醉科  
王建雄 067000,河北省承德市,承德市中心医院麻醉科  
张凌岚 067000,河北省承德市,承德市中心医院麻醉科  
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中文摘要:
      
目的：探讨喉罩联合支气管封堵器（BB）对胸腔镜肺部分切除术患者术后肺功能的影响。
方法：选择2023年4月至2024年10月择期行胸腔镜下单侧肺部分切除手术患者104例，男64例，女40例，年龄18～64岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：喉罩联合BB组（B组）和双腔支气管插管（DLT）组（D组），每组52例。B组采用喉罩联合BB，D组采用DLT，进行单肺通气（OLV）。以胸骨旁线、腋前线、腋后线及两乳头间连线将健侧肺分成6个区域，应用床旁肺超声进行评估。记录麻醉诱导前即刻、拔除通气工具后肺超声评分（LUS）、肺萎陷评分和外科医师满意度评分。记录置入通气工具即刻（T0）、OLV开始即刻（T1）、OLV 20 min（T2）、OLV结束即刻（T3）的气道峰压（Ppeak）、平台压（Pplat）和肺动态顺应性（Cdyn）。记录术前24 h、术后即刻、术后24 h血清IL-6、TNF-α和CRP浓度。记录术前1 d、术后6 h咽痛VAS疼痛评分与术后3 d肺部并发症（PPCs）的发生情况。
结果：与D组比较，B组术后即刻、术后24 h血清IL-6、CRP和TNF-α浓度、术后6 h咽痛VAS疼痛评分均明显降低（P<0.05）。两组麻醉前即刻、拔除通气工具后LUS、术中肺萎陷评分和术后外科医师满意度评分、T0—T3时Ppeak、Pplat和Cdyn、术后3 d肺部感染、肺不张和胸腔积液发生率差异均无统计学意义。
结论：喉罩联合BB用于胸腔镜下肺部分切除术患者，可以降低术后早期炎性因子浓度，减轻术后早期咽痛，不增加健侧肺术后LUS评分和PPCs的发生风险。
英文摘要:
      
Objective: To observe the effect of laryngeal mask combined with bronchial blocker (BB) in thoracoscopic partial lobectomy on pulmonary function.
Methods: A total of 104 patients, 64 males and 40 females, aged 18-64 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ-Ⅲ, from April 2023 to Octomber 2023, selected for thoracoscopic partial lobectomy, were divided into two groups using a random number table method: laryngeal mask combined with BB group (group B) and double-lumen endotracheal tube (DLT) group (group D), 52 patients in each group. Laryngeal mask combined with BB were used in group B, DLT was used in group D during one-lung ventilation (OLV). All of the intercostal spaces of the anterior, lateral and posterior regions of both lungs (6 regions per side) are evaluated by lung ultrasound. The lung ultrasound score (LUS), the lung collapse score, and surgeon satisfaction immediately before anesthesia and after remove ventilation tools, peak airway pressure (Ppeak), plateau pressure (Pplat), and dynamic lung compliance (Cdyn) at placement of ventilation device (T0), beginning of OLV (T1), 20 minutes after OLV (T2), completion of OLV (T3), IL-6, CRP, TNF-α levels 24 hours before operation, the end of operation, 24 hours after operation, VAS pain scores of sore throat 1 day before operation and 6 hours after operation, and postoperative pulmonary complications (PPCs) 3 days after operation were recored.
Results: Compared with group D, IL-6, CRP, TNF-α levels at the end of operation, 24 hours after operation, and VAS pain scores of sore throat 6 hours after operation were significantly lower in group B (P < 0.05). There were no significant differences in LUS immediately before anesthesia and after remove ventilation tools, the lung collapse score and surgeon satisfaction, Ppeak, Pplat, and Cdyn from T0-T3, postoperative pulmonary complications 3 days after operation between the two groups.
Conclusion: Laryngeal mask combined with bronchial blocker in thoracoscopic partial lobectomy can reduce the pain of postoperative sore throat and the levels of inflammatory factors without increasing the LUS and the risk of PPCs.
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