【摘要】 目的 比较支气管封堵器 （BB） 与双腔支气管导管 （DLT） 对开胸前肺萎陷效果的影响。方法 选取择期行电视胸腔镜下左肺叶切除术的患者72例，采用随机数表法分为3组 （n = 24）:DLT常规萎陷组 （DLT 组）、DLT 开胸前肺萎陷技术组 （PTLCT-DLT 组） 和 BB 开胸前肺萎陷技术组 （PTLCT-BB组）。其中，PTLCT-DLT 组和 PTLCT-BB 组中分别有 2 例和 1 例发生低氧血症 [经皮动脉血氧饱和度（Sp O₂） < 90%]，被剔除，最终 DLT 组 24 例、PTLCT-DLT 组 22 例、PTLCT-BB 组 23 例完成该项研究。DLT 组右侧卧位前左通道被夹闭并向空气开放，PTLCT-DLT 组双肺纯氧通气并在侧卧位前夹闭左通道，PTLCT-BB 组在侧卧位前封堵左支气管，排气管被故意堵塞。比较 3 组患者侧卧位即时 （T₁）、单肺通气8 min （T₂）、单肺通气 10 min （T₃） 和开胸后 2 min （T₄） 的心率 （HR）、收缩压 （SBP）、舒张压 （DBP）、Sp O₂和动脉血氧分压 （Pa O₂），记录3组患者在胸腔镜置入即刻的肺萎陷评分（LCS）。结果 与DLT组比较，PTLCT-DLT 组和 PTLCT-BB 组的 LCS 明显升高 （P < 0.05）,PTLCT-DLT 组与 PTLCT-BB 组比较，差异无统计学意义 （P > 0.05）。在T₃时点，PTLCT-DLT组和PTLCT-BB组Sp O₂较DLT组明显降低 （P < 0.05）,PTLCT-DLT组和PTLCT-BB组在T₂和T₃时点Pa O₂较DLT组明显降低 （P < 0.05），在T₄时点较DLT组明显升高 （P < 0.05）。结论 开胸前肺萎陷技术有助于BB和DLT完成开胸前肺萎陷，两者对开胸前肺萎陷的影响无差异。更多还原

【Abstract】 Objective To compare the effect of bronchial blocker （BB） and double-lumen endotracheal tube（DLT） on pre-thoracotomy lung collapse in thoracoscopic surgery. Methods 72 patients underwent elective thoracoscopic left lung surgery, were randomly divided into 3 groups （n = 24）: double-lumen endotracheal tube group （DLT group）, DLT with PTLCT group （PTLCT-DLT group） and bronchial blocker with PTLCT group（PTLCT-BB group）. Two patients in group PTLCT-DLT and one patient in group PTLCT-BB group were excluded due to hypoxemia [（percutaneous arterial oxygen saturation, Sp O₂） < 90%)]. Eventually, 24 patients in the DLT group, 22 patients in the PTLCT-DLT group, and 23 patients in the PTLCT-BB group completed. The left channel was clamped and opened to air before right lateral position in DLT group. Patients in the PTLCT-DLT were treated by using the double lung ventilation with Fi O₂= 1.0 and the left channel was blocked before changing into the lateral position. In the PTLCT-BB group, the operative bronchus was blocked before changing into the lateral position, and the BB suction tube was intentionally blocked. Heart rate （HR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, Sp O₂, and arterial partial pressure of oxygen （Pa O₂） were recorded in each group at the following four time points: immediately in lateral position （T₁）, one-lung ventilation 8 min （T₂）, one-lung ventilation 10 min（T₃）, 2 min after pleura opening （T₄）. The operated lung was evaluated using lung collapse scale （LCS） immediately after opening the pleura. Results Compared with DLT group, the LCS of PTLCT-DLT group and PTLCT-BB group were significantly increased （P < 0.05）, and there was no significant difference in LCS between the PTLCT-DLT group and PTLCT-BB group （P > 0.05）. At T₃, compared with DLT group, the Sp O₂of PTLCT-DLT group and PTLCT-BB group were significantly decreased （P < 0.05）. Compared with DLT group, the Pa O₂of PTLCT-DLT group and PTLCT-BB group were significantly decreased at T₂and T₃（P < 0.05） and were significantly increased at T₄（P < 0.05）. Conclusion PTLCT can helps BB and DLT to complete the pre-thoracotomy lung collapse, there was no difference in the effect of the two on pre-thoracotomy lung collapse.更多还原