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喉罩联合支气管封堵器在胸外科单肺通气患者中的应用效果:一项回顾性研究。

The effect of laryngeal mask combined with bronchial occluder in patients undergoing single lung ventilation in thoracic surgery: A retrospective study.

作者信息

Wang Wanling, Sun Yanbin, Zhao Zhenru, Guan Jiao

机构信息

Department of Anesthesiology, Chengde Central Hospital, Chengde, Hebei, P.R. China.

出版信息

Medicine (Baltimore). 2025 Mar 14;104(11):e41718. doi: 10.1097/MD.0000000000041718.

DOI:10.1097/MD.0000000000041718
PMID:40101037
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11922447/
Abstract

This study evaluates the clinical efficacy of combining a laryngeal mask airway with a bronchial blocker (LMA-BB) in single-lung ventilation (OLV) during thoracic surgery compared to the traditional single-lumen tracheal tube with a bronchial blocker (single-lumen tracheal tube [SLT] + BB). A retrospective analysis was performed on 93 patients undergoing thoracic surgery with OLV from December 2021 to September 2023. After propensity score matching (1:1), 34 patients remained in each group (LMA-BB and SLT + BB). Key outcomes, including airway pressures, ventilation and oxygenation parameters, lung compliance, postoperative recovery, and complications, were compared between groups. After matching, the 2 groups had similar baseline characteristics. The LMA-BB group showed significant advantages in airway pressure management, with lower peak and plateau pressures (P < .05). Ventilation and oxygenation efficiency were superior in the LMA-BB group, including lower end-tidal carbon dioxide (37.8 ± 4.7 vs 39.2 ± 5.1 mm Hg, P = .04) and higher oxygenation index (255 ± 22 vs 245 ± 28, P = .04). Lung compliance was improved (P = .018), and more patients in the LMA-BB group achieved excellent lung collapse (76.5% vs 52.9%, P = .032). Additionally, postoperative recovery was faster, with shorter extubation times (12.4 ± 3.2 vs 14.8 ± 3.6 minutes, P = .003) and fewer complications, including hypoxemia (5.9% vs 23.5%, P = .027) and pulmonary issues (8.8% vs 20.6%, P = .046). The LMA-BB technique offers significant clinical benefits over the traditional SLT + BB method in thoracic OLV, including improved airway management, ventilation efficiency, lung compliance, and faster recovery. It also reduces postoperative complications, making it a promising alternative for thoracic surgery.

摘要

本研究评估了在胸外科手术单肺通气(OLV)中,喉罩气道联合支气管阻塞器(LMA-BB)相较于传统单腔气管导管联合支气管阻塞器(单腔气管导管[SLT]+BB)的临床疗效。对2021年12月至2023年9月期间接受OLV胸外科手术的93例患者进行回顾性分析。经过倾向评分匹配(1:1)后,每组各有34例患者(LMA-BB组和SLT+BB组)。比较两组之间的关键指标,包括气道压力、通气和氧合参数、肺顺应性、术后恢复情况及并发症。匹配后,两组的基线特征相似。LMA-BB组在气道压力管理方面具有显著优势,其峰值和平台压较低(P<0.05)。LMA-BB组的通气和氧合效率更高,包括更低的呼气末二氧化碳分压(37.8±4.7 vs 39.2±5.1 mmHg,P=0.04)和更高的氧合指数(255±22 vs 245±28,P=0.04)。肺顺应性得到改善(P=0.018),LMA-BB组更多患者实现了良好的肺萎陷(76.5% vs 52.9%,P=0.032)。此外,术后恢复更快,拔管时间更短(12.4±3.2 vs 14.8±3.6分钟,P=0.003),并发症更少,包括低氧血症(5.9% vs 23.5%,P=0.027)和肺部问题(8.8% vs 20.6%,P=0.046)。在胸科OLV中,LMA-BB技术相较于传统的SLT+BB方法具有显著的临床优势,包括改善气道管理、通气效率、肺顺应性以及更快的恢复。它还减少了术后并发症,使其成为胸外科手术的一个有前景的替代方案。

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本文引用的文献

1
Laryngeal mask airway combined with bronchial blocker achieved 1-lung ventilation in a patient with bilateral vocal cord paralysis: A case report.喉罩联合支气管封堵器在双侧声带麻痹患者中实现单肺通气:1 例报告。
Medicine (Baltimore). 2024 Mar 8;103(10):e37409. doi: 10.1097/MD.0000000000037409.
2
One-lung ventilation with a bronchial blocker in thoracic patients.单侧肺通气伴支气管封堵器在胸科患者中的应用。
BMC Anesthesiol. 2023 Dec 6;23(1):398. doi: 10.1186/s12871-023-02362-z.
3
Combined use of the ProSeal laryngeal mask airway and a bronchial blocker vs. a double-lumen endobronchial tube in thoracoscopic surgery: A randomized controlled trial.喉罩与支气管封堵器联合应用与双腔支气管导管在胸腔镜手术中的比较:一项随机对照试验。
J Clin Anesth. 2023 Sep;88:111136. doi: 10.1016/j.jclinane.2023.111136. Epub 2023 May 1.
4
Systematic Review and Meta-Analysis of Efficiency and Safety of Double-Lumen Tube and Bronchial Blocker for One-Lung Ventilation.双腔管与支气管封堵器用于单肺通气的有效性和安全性的系统评价与Meta分析
J Clin Med. 2023 Feb 27;12(5):1877. doi: 10.3390/jcm12051877.
5
A combination of supraglottic airway and bronchial blocker for one-lung ventilation in infants undergoing thoracoscopic surgery.声门上气道与支气管封堵器联合用于胸腔镜手术婴儿的单肺通气
Heliyon. 2023 Feb 9;9(2):e13576. doi: 10.1016/j.heliyon.2023.e13576. eCollection 2023 Feb.
6
A comparison between bronchial blockers and double-lumen tubes for patients undergoing lung resection: A propensity score-matched cohort study.支气管阻塞器与双腔管用于肺切除术患者的比较:倾向评分匹配队列研究。
Int J Med Sci. 2022 Sep 25;19(11):1706-1714. doi: 10.7150/ijms.75835. eCollection 2022.
7
The association between double-lumen tube versus bronchial blocker and postoperative pulmonary complications in patients after lung cancer surgery.肺癌手术后患者双腔管与支气管封堵器的使用与术后肺部并发症之间的关联。
Front Oncol. 2022 Sep 27;12:1011849. doi: 10.3389/fonc.2022.1011849. eCollection 2022.
8
Recent Advances in Videolaryngoscopy for One-Lung Ventilation in Thoracic Anesthesia: A Narrative Review.胸段麻醉中用于单肺通气的视频喉镜的最新进展:一项叙述性综述
Front Med (Lausanne). 2022 Jun 13;9:822646. doi: 10.3389/fmed.2022.822646. eCollection 2022.
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Comparison of left double lumen tube and y-shaped and double-ended bronchial blocker for one lung ventilation in thoracic surgery-a randomised controlled clinical trial.左双腔管与 Y 型双端支气管阻塞器在胸外科单肺通气中的比较:一项随机对照临床试验。
BMC Anesthesiol. 2022 Apr 2;22(1):92. doi: 10.1186/s12871-022-01637-1.
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Langenbecks Arch Surg. 2022 Aug;407(5):1891-1900. doi: 10.1007/s00423-022-02475-y. Epub 2022 Mar 21.