Cheng Qian, He Zhiyong, Xue Ping, Xu Qianyun, Zhu Minmin, Chen Wankun, Miao Changhong
Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
J Thorac Dis. 2020 Mar;12(3):876-882. doi: 10.21037/jtd.2019.12.75.
One-lung ventilation (OLV) is becoming an essential component of thoracic anesthesia. The two principal devices used for OLV are a double-lumen tube (DLT) and a bronchial blocker (BB). We hypothesized that the use of a BB with the disconnection technique would improve the quality of lung collapse in video-assisted thoracoscopic surgery (VATS).
Seventy-five patients undergoing scheduled VATS were enrolled in this study and were randomly divided into two groups: a left-sided DLT group (Group D) and a BB with the disconnection technique group (Group B). OLV was initiated when the surgeon performed the skin incision. In Group D, the left channel of the DLT was opened to the air. In Group B, the lung was deflated via the disconnection technique, thus opening the breathing circuit to the air fifteen seconds after opening the pleura. The mean arterial pressure (MAP) and heart rate (HR) during induction; the quality of lung collapse 1 and 10 minutes after pleural opening; the time required for complete lung collapse; the correct placement of the device; and the number of patients suffering from a sore throat after surgery were recorded.
Compared with the use of the DLT, the use of the BB with the disconnection technique was associated with a similar quality of lung collapse, a comparable required time for total lung collapse (P>0.05, respectively), a lower incidence of sore throat both when leaving the PACU and 24 hours after surgery (34.2% 13.5%, 15.8% 5.4%, P<0.05, respectively) and fewer hemodynamic fluctuations after intubation both one and ten minutes after pleural opening.
The use of a BB with the disconnection technique in VATS offers an effective method for improving the quality of lung collapse and reducing postoperative sore throat.
单肺通气（OLV）正成为胸段麻醉的重要组成部分。用于OLV的两种主要装置是双腔气管导管（DLT）和支气管封堵器（BB）。我们假设采用断开技术的BB在电视辅助胸腔镜手术（VATS）中能提高肺萎陷的质量。
75例计划行VATS的患者纳入本研究，并随机分为两组：左侧DLT组（D组）和采用断开技术的BB组（B组）。当外科医生进行皮肤切口时开始OLV。在D组，DLT的左通道与大气相通。在B组，通过断开技术使肺萎陷，即在打开胸膜后15秒将呼吸回路与大气相通。记录诱导期间的平均动脉压（MAP）和心率（HR）；打开胸膜后1分钟和10分钟时肺萎陷的质量；完全肺萎陷所需的时间；装置的正确放置情况；以及术后咽痛患者的数量。
与使用DLT相比，采用断开技术的BB在肺萎陷质量方面相似，完全肺萎陷所需时间相当（P均>0.05），离开麻醉后监护室（PACU）时和术后24小时咽痛的发生率更低（分别为34.2%对13.5%，15.8%对5.4%，P均<0.05），并且在打开胸膜后1分钟和10分钟插管后血流动力学波动更小。
在VATS中采用断开技术的BB为提高肺萎陷质量和减少术后咽痛提供了一种有效方法。
