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| 喉罩联合支气管封堵器对胸腔镜肺切除术患者术中肺功能的影响 |
| Effect of laryngeal mask airway combined with bronchial blocker on intraoperative pulmonary function in patients undergoing thoracoscopic pneumonectomy |
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| DOI：10.12089/jca.2025.11.003 |
| 中文关键词: 喉罩 支气管封堵器 胸腔镜 单肺通气 肺功能 肺切除术 |
| 英文关键词: Laryngeal mask airway Bronchial blocker Thoracoscopy One-lung ventilation Pulmonary function Pneumonectomy |
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| 中文摘要: |
目的：观察喉罩联合支气管封堵器对胸腔镜肺切除术患者术中肺功能的影响。
方法：选择择期全麻下胸腔镜肺切除术患者162例，男88例，女74例，年龄18～75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：气管插管联合支气管封堵器组（E组）和喉罩联合支气管封堵器组（L组），每组81例。记录建立有效气道后双肺通气10 min、单肺通气（OLV） 30 min、恢复双肺通气10 min时肺功能指标：气道峰压（Ppeak）、气道平均压（Pmean）、肺动态顺应性（Cdyn）、PaO2/FiO2和肺内分流率（Qs/Qt）。记录OLV 1、5、10 min肺萎陷质量评分。记录术后拔管或喉罩时间、PACU滞留时间、苏醒期低氧血症和术后7 d内术后肺部并发症（PPCs）的发生情况。
结果：与建立有效气道后双肺通气10 min比较，两组OLV 30 min和恢复双肺通气10 min时Cdyn、PaO2/FiO2明显降低，Ppeak、Pmean、Qs/Qt明显升高（P＜0.05）。与E组比较，L组建立有效气道后双肺通气10 min、OLV 30 min和恢复双肺通气10 min时PaO2/FiO2明显升高，Ppeak、Pmean、Qs/Qt均明显降低（P＜0.05）。与E组比较，L组术后拔管或喉罩时间、PACU滞留时间明显缩短，苏醒期低氧血症发生率明显降低（P＜0.05）。两组术中均成功实施肺萎陷，在OLV 1、5和10 min时肺萎陷质量评分差异无统计学意义。两组术后7 d内PPCs发生率差异无统计学意义。
结论：喉罩联合支气管封堵器用于胸腔镜肺切除术患者，可降低气道峰压和平均压，减少肺内分流，改善氧合。 |
| 英文摘要: |
Objective: To observe the effect of laryngeal mask airway combined with bronchial blocker on intraoperative pulmonary functionin patients undergoing thoracoscopic pneumonectomy.
Methods: A total of 162 patients who scheduled for elective thoracoscopic pneumonectomy under general anesthesia, 88 males and 74 females, aged 18-75 years, BMI 18.5-30.0 kg/m2 , ASA physical status Ⅰ-Ⅲ, were enrolled in the study. The patients were divided into two groups using random number method: endotracheal intubation combined with bronchial blocker group (group E) and laryngeal mask airway combined with bronchial blocker group (group L), 81 patients in each group. Pulmonary function indices including peak airway pressure (Ppeak), mean airway pressure (Pmean), dynamic lung compliance (Cdyn), PaO2/FiO2, intrapulmonary shunt (Qs/Qt) were recorded 10 minutes after establishing an effective airway with two-lung ventilation, 30 minutes after one-lung ventilation (OLV), and 10 minutes after resuming two-lung ventilation. Additionally, the quality score of lung collapse was recorded at 1 minute, 5 and 10 minutes of OLV. The time of extubation or removal of the laryngeal mask after operation, the length of postanesthesia care unit (PACU) retention, the incidence of hypoxemia in the anesthesia recovery period, and the incidence of postoperative pulmonary complications (PPCs) within 7 days postoperatively were recorded.
Results: Compared with 10 minutes after establishing an effective airway with two-lung ventilation, Cdyn and PaO2/FiO2 were significantly decreased in both groups 30 minutes after one-lung ventilation and 10 minutes after resuming two-lung ventilation, while Ppeak, Pmean, and Qs/Qt were significantly increased (P < 0.05). Compared with group E, PaO2/FiO2 in the group L was significantly increased 10 minutes after establishing an effective airway with two-lung ventilation, 30 minutes after one-lung ventilation and 10 minutes after resuming two-lung ventilation, while Ppeak, Pmean, and Qs/Qt were significantly decreased (P < 0.05). Compared with group E, the time of extubation or removal of the laryngeal mask after operation and the PACU retention time were significantly shortened, and the incidence of hypoxemia during the recovery period were significantly decreased (P < 0.05). Both groups of patients successfully achieved lung collapse during the operation, and there were no statistically significant difference in the lung collapse scores at 1 minute, 5 and 10 minutes of OLV. The incidence of PPCs within 7 days postoperatively had no statistically signifcant differences between the two groups.
Conclusion: The combination of laryngeal mask airway and bronchial blocker can reduce peak airway pressure and mean airway pressure, decrease intrapulmonary shunt, and improve oxygenation in patients undergoing thoracoscopic pneumonectomy. |
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