目的 探讨支气管封堵器用于小切口微创心脏瓣膜手术的临床价值.方法 选择2021年1月至2021年6月行微创心脏瓣膜手术的患者64例,年龄18～65周岁,按照随机数字表法,分为双腔支气管导管组(对照组,32例)和支气管封堵器组(试验组,32例).观察并比较两组患者插管定位时间与肺萎陷效果、插管期间血流动力学的变化、单肺通气效果及并发症发生情况.结果 与对照组[(272.03±46.65)s]相比,试验组插管定位的时间[(210.81±17.56)s]明显缩短(P<0.05);两组术中肺萎陷质量相近,各时间点的PaO2和PaCO2差异无统计学意义(P>0.05).两组患者气管插管后心率(HR)及平均动脉压(MAP)较插管前(T1)均有所上升,但相比于对照组,试验组插管即刻(T2)和插管后1分钟(T3)HR较慢[(88.72±11.42)次/min vs(95.16±9.87)次/min,(83.09±11.13)次/min vs(89.44±10.15)次/min;均P<0.05],T2和T3时的MAP也较低[(86.0±11.13)mmHg vs(95.19±10.04)mmHg,(82.34±10.86)mmHg vs(90.56±9.79)mmHg;均P<0.05].单肺通气后10分钟(T5)及体外循环结束后单肺通气10分钟(T6)时,两组患者单肺通气期间气道峰压(Ppeak)和气道平台压(Pplat)比单肺通气前(T4)有所升高,且对照组气道压升高更为明显[(21.50±2.41)cmH2O vs(24.69±3.48)cmH2O,(22.25±2.26)cmH2O vs(25.19±3.34)cmH2O;均P<0.05].试验组较对照组术后咽痛(6.25% vs 18.75%)和声音嘶哑(3.13% vs 15.63%)发生率低,P<0.05.结论 支气管封堵器可产生良好的单肺通气效果,操作简单方便,插管刺激小,并能明显降低术后咽痛和声嘶的发生率,可安全有效地用于微创心脏瓣膜手术.
Clinical value of bronchial blockers in small-incision minimally invasive cardiac valve surgery
Objective To investigate the clinical value of bronchial blockers in small-incision minimally invasive cardiac valve surgery.Methods Sixty-four patients, aged 18-65 years old, who underwent minimally invasive cardiac valve surgery in the Department of Cardiovascular Surgery at our hospital from January 2021 to June 2021 were selected.According to the method of one-lung ventilation during surgery, the patients were randomly divided into double-lumen bronchial tube group (control group, 32 cases) and bronchial blocker group (experimental group, 32 cases).The hemodynamic changes during intubation, the effectiveness of one-lung ventilation and the incidence of complications were reviewed and compared between the two groups.Results Compared to control group [(272.03±46.65)s], the intubation positioning time of experimental group [(210.81±17.56)s] was significantly shorter (P<0.05).The quantity of pulmonary atrophy was almost the same in both groups, and there was no statistically significant difference in PaO2 and PaCO2 at all time points (P>0.05).The heart rate (HR) and mean arterial pressure (MAP) were increased in both groups after intubation compared to before intubation (T1).However, the HR were slower in experimental group immediately after intubation (T2) and 1 min after intubation (T3) [(88.72±11.42) beats/min vs (95.16±9.87) beats/min, (83.09±11.13) beats/min vs (89.44±10.15) beats/min, both P<0.05], and the MAP at T2 and T3 were lower [(86.0±11.13) mmHg vs (95.19±10.04) mmHg, (82.34±10.86) mmHg vs (90.56±9.79) mmHg, both P<0.05].Compared with before one-lung ventilation (T4), the peak airway pressure (Ppeak) and plateau airway pressure (Pplat) were also increased in both groups at 10 min after one-lung ventilation (T5) and at 10 min after one-lung ventilation at the end of cardiopulmonary bypass (T6), with a more significant increase in control group [(21.50±2.41) cmH2O vs (24.69±3.48) cmH2O, (22.25±2.26) cmH2O vs (25.19±3.34) cmH2O, both P<0.05].The incidence of postoperative sore throat (6.25% vs 18.75%) and hoarseness (3.13% vs 15.63%) was lower in experimental group (P<0.05).Conclusion Bronchial blockers can provide good effect of one lung ventilation.They are easy and convenient to use with less intubation stimulation and can significantly reduce the incidence of postoperative sore throat and hoarseness.Therefore, bronchial blockers can be used in minimally invasive cardiac valve surgery safely and effectively.
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