【作者】 陈洁；

【导师】 钟泰迪；

【作者基本信息】 浙江大学 ， 外科学， 2005， 硕士

【摘要】 单肺通气(one-lung ventilation,OLV)可通过双腔支气管导管(Double-lumen Tube,DLT)技术和支气管阻塞(bronchial　blocker,BB)技术来实现。DLT在临床上使用最普遍,但DLT的有效管腔小、病人术后不易耐受而常需换管、声门暴露不佳者插管困难及没有小儿的型号等缺点使其使用范围受到限制。带扭力控制阻塞装置(Torque Control Blocker)的Univent管、即TCB Univent管(TCBU)是支气管阻塞器的一种,可弥补DLT的上述缺陷,但因近几年才开始使用,临床应用及报道较少。本研究采取随机对照的方法,在择期胸科手术需单肺通气的病人中,通过比较DLT和TCBU的插管定位时间、盲插成功率、气道峰压增加率、移位次数、需行纤支镜检查的次数、术野暴露情况、术后咽痛声嘶发生率等指标,来评价何者更优。更多还原

【Abstract】 Techniques for One - lung ventilation ( OLV ) can be accomplished in two different ways. The first method involves the use of a double-lumen endotracheal tube ( DLT ).The second method involves blockade of a mainstem bronchus to allow lung collapse distal to the occlusion ( bronchial blocker). Although the DLTs are the most common devices used during lung separation techniques, they are still some pitfalls. Thetorque control blocker univent tube (TCBU) is one of the devices used in bronchial blocker technique, and in some specific clinical situations it can offer more advantages over the DLT. Because the TCBU is a new bronchial blocker, there are few study to report its effectiveness compared with DLT in one-lung ventilation during elective thoracic surgical cases. Therefore, in this study, a prospective, randomized trial was designed to compare the DLT with the TCBU to determine whether there were objective advantages of one over the other during OLV.ObjectiveThere are few study about comparing the DLT with the TCBU. The objective of this study is to compare the DLT with the TCBU and to determine whether there are objective advantages of one over the other in one-lung ventilation during elective thoracic surgical cases.Materials and Methods60 patients needing one-lung ventilation during elective thoracic surgical cases were randomly divided into Group D and Group U. The patients in Group D (n=30) were intubated with Double-lumen Tube and who in Group U (n=30) were intubated with TCBU. The following variables were recorded and compared: 1) time required for intubation and position each tube, 2) ration of successful blind intubation, 3) increase in airway peak pressure (PIP), 4) frequency of malpositions, 5) number of times that the fiberoptic was achieved, 6)surgical exposure, and 7) frequency of sore throat or hoarseness.ResultsStatistical difference were found in increase of PIP and frequency of sore throat (p < 0.05). No statistical difference were found in the time required to intubation and position each tube, the ration of successful blind intubation, the frequency of malpositions, the number of times that thefiberoptic was achieved and the surgical exposure (p > 0.05).ConclusionTCB univent applied for one-lung ventilation is as good as DLT, and in some specific clinical situations it can offer more advantages over the DLT.更多还原