Ye Jing, Gu Miao-Ning, Zhang Chao-Qun, Cai Kai-Can, Cai Rui-Jun
Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2009 Nov;29(11):2244-7.
To compare the differences in intrapulmonary shunt (Qs/Qt) and arterial oxygenation between selective left lower lobar blockade by Coopdech endobronchial blocker tubes (BB) and one lung ventilation (OLV) by left-sided double-lumen endobronchial tubes (DLT) in patients with normal pulmonary function.
Thirty-six patients (aged 32-64 years) scheduled for lower esophageal surgery were allocated randomly into BB and DLT groups (n=18). Anesthesia was induced and maintained with Propofol by target controlled infusion with intravenous administration of sufentanil and cisatracurium if needed. A 35 to 39 French tube was placed in the DLT group, and an 8.0-mm (internal diameter) single-lumen endotracheal tube was used in the BB group where a 9 French Coopdech BB was advanced into the left lower lobar bronchus guided by a fiberoptic bronchoscope. The variables recorded were blood gas analysis data from the venous and arterial blood samples at 20 min after two-lung ventilation in supine position (T(1)), 20 min after initiation of one-lung ventilation or selective left lower lobar blockade by inflating BB balloons in the right lateral decubitus position (T(2)), total collapse of the left lung or the left lower lobe after the pleura was opened (T(3)), and before tracheal extubation (T(4)). Qs/Qt was calculated using a standard formula based on the three-compartment model. Upon pleura opening, the effectiveness of lung collapse was evaluated by the surgeon who performed the surgery. Chest radiograph and arterial blood gas analyses were performed the day after the operation.
Both of the groups were similar with regard to rank of the surgical exposure, pH, PaCO(2), hemoglobin from T(1) to T(4), Qs/Qt, PaO(2), PO(2), and oxygenation index at T1. In BB group, a significant reduction of Qs/Qt and greater improvements in PaO(2), PO(2), oxygenation index at T(2), T(3) and T(4) were observed in comparison with those in DLT group (P<0.05 or <0.01). No lobe collapse was observed postoperatively in BB group, but 2 patients in DLT group showed left lower lobe atelectasis. The patients in BB group showed better postoperative arterial oxygenation and shorter postoperative hospital stay (P<0.01).
Selective left lower lobar blockade by Coopdech endobronchial blocker tube during lower esophageal surgery provides a lower intraoperative intrapulmonary shunt and a better intra- and postoperative arterial oxygenation..
比较在肺功能正常的患者中，使用Coopdech支气管内封堵管（BB）进行选择性左下叶封堵与使用左侧双腔支气管导管（DLT）进行单肺通气（OLV）时肺内分流（Qs/Qt）和动脉氧合的差异。
将36例计划行食管下段手术的患者（年龄32 - 64岁）随机分为BB组和DLT组（n = 18）。采用丙泊酚靶控输注诱导并维持麻醉，必要时静脉注射舒芬太尼和顺式阿曲库铵。DLT组放置35至39F的导管，BB组使用内径8.0mm的单腔气管导管，并在纤维支气管镜引导下将9F的Coopdech BB推进左下叶支气管。记录的变量包括仰卧位双肺通气20分钟（T(1)）、右侧卧位单肺通气开始或通过充盈BB球囊进行选择性左下叶封堵20分钟（T(2)）、打开胸膜后左肺或左下叶完全萎陷（T(3)）以及气管拔管前（T(4)）时静脉和动脉血样本的血气分析数据。Qs/Qt使用基于三室模型的标准公式计算。打开胸膜时，由实施手术的外科医生评估肺萎陷的效果。术后第一天进行胸部X线片和动脉血气分析。
两组在手术暴露等级、pH、PaCO(2)、从T(1)到T(4)的血红蛋白、Qs/Qt、PaO(2)、PO(2)以及T1时的氧合指数方面相似。与DLT组相比，BB组在T(2)、T(3)和T(4)时Qs/Qt显著降低，PaO(2)、PO(2)和氧合指数有更大改善（P < 0.05或<0.01）。BB组术后未观察到肺叶萎陷，但DLT组有2例患者出现左下叶肺不张。BB组患者术后动脉氧合更好，术后住院时间更短（P < 0.01）。
在食管下段手术中，使用Coopdech支气管内封堵管进行选择性左下叶封堵可降低术中肺内分流，并改善术中和术后的动脉氧合。
