本文選題：單肺通氣 + 支氣管堵塞器�。� 參考：《南昌大學》2017年碩士論文

【摘要】：目的:探討支氣管堵塞器與雙腔支氣管導管應(yīng)用于食管癌根治術(shù)患者的臨床應(yīng)用效果比較。方法:選擇于我院行擇期食管癌根治手術(shù)治療的60名食管癌患者,根據(jù)術(shù)中單肺通氣方式,將其隨機分為2組:支氣管堵塞器組(BBs組)和雙腔支氣管導管組(DLT組)。所有患者經(jīng)麻醉誘導后,BBs組先經(jīng)口插入單腔氣管導管,隨后于纖維支氣管鏡引導下向相應(yīng)側(cè)別支氣管內(nèi)插入支氣管堵塞器。DLT組經(jīng)口插入雙腔支氣管導管,隨后用纖維支氣管鏡調(diào)整其位置。術(shù)中、術(shù)后嚴格監(jiān)測并記錄以下指標:(1).記錄患者一般情況(性別、年齡、身高、體重及ASA分級)、肺萎陷側(cè)別、單肺通氣時間。(2)術(shù)側(cè)肺萎陷用時、單肺通氣時氣道阻力的大小、肺萎陷評分;(3)單肺通氣結(jié)束后立即取橈動脈血進行血氣分析,記錄PH、PaO2、PaCO2、HCO3-、BE的結(jié)果;(4)ELISA法檢測單肺通氣結(jié)束前通氣側(cè)肺泡灌洗液中TNF-α、IL-6和IL-8的含量;(5)隨訪氣管拔管后24h內(nèi)聲嘶、咽痛的發(fā)生情況和術(shù)后72h內(nèi)肺部并發(fā)癥的發(fā)生情況。結(jié)果:1.兩組間患者一般情況、肺萎陷側(cè)別、單肺通氣時間無統(tǒng)計學差異(均為P0.05)。2.單肺通氣時氣道阻力BBs組明顯低于DLT組(P0.05),而術(shù)側(cè)肺萎陷用時BBs組較DLT組顯著延長(P0.05),兩組間肺萎陷評分差異無統(tǒng)計學意義(P0.05)。3.BBs組和DLT組間單肺通氣結(jié)束即刻的動脈血氣結(jié)果各項指標(PH、PaO2、PaCO2、HCO3-、BE)差異無統(tǒng)計學意義(均為P0.05)。4.單肺通氣結(jié)束前,BBs組肺泡灌洗液中TNF-α、IL-6和IL-8的含量較DLT組顯著下降(均為P0.05)。5.BBs組術(shù)后咽痛發(fā)生率顯著低于DLT組(P0.05),而兩組間術(shù)后聲嘶和肺部并發(fā)癥的發(fā)生率差異無統(tǒng)計學意義(均為P0.05)。結(jié)論:1.食管癌根治術(shù)中,支氣管堵塞器與雙腔支氣管導管相比,具有氣道阻力低、肺組織炎性因子影響小、術(shù)后咽痛發(fā)生率低的優(yōu)勢。而前者肺萎陷時間更長。2.支氣管堵塞器與雙腔支氣管導管對術(shù)中動脈血氣的影響、肺萎陷評分、術(shù)后聲嘶和肺部并發(fā)癥的發(fā)生率并無顯著區(qū)別。
[Abstract]:Objective: to compare the clinical effects of bronchial occluder and double lumen bronchial catheter in radical resection of esophageal carcinoma.Methods: sixty patients with esophageal cancer undergoing radical resection of esophageal carcinoma were randomly divided into two groups: bronchial occluder group (BBs group) and double lumen bronchial catheter group (DLT group).After anesthesia induction, the BBs group first inserted a single lumen tracheal catheter through the mouth, and then, under the guidance of fiberbronchoscope, the bronchial occluder was inserted into the corresponding lateral bronchus. The DLT group inserted a double-lumen bronchial catheter through the mouth.The position was then adjusted with a fiberoptic bronchoscope.During and after operation, the following indexes were strictly monitored and recorded.The patients' general condition (sex, age, height, weight, ASA grade, lung collapse side, time of one-lung ventilation) were recorded.Lung atrophy score / 3) Radial artery blood was taken immediately after one-lung ventilation for blood gas analysis. The results of PHPao _ 2 and Paco _ 2H _ CO _ 3-OBE were recorded. The levels of TNF- 偽 IL-8 and TNF- 偽 IL-8 in pulmonary alveolar lavage fluid were detected by Elisa before the end of single lung ventilation). After tracheal extubation, there was hoarseness within 24 hours after tracheal extubation.The incidence of pharyngeal pain and pulmonary complications within 72 hours after operation.The result is 1: 1.There was no significant difference between the two groups in the general condition of the patients, the side of lung collapse, and the time of single lung ventilation (P0.05. 2. 2).The airway resistance in BBs group was significantly lower than that in DLT group (P 0.05), but the lung atrophy in BBs group was significantly longer than that in DLT group. There was no significant difference in pulmonary collapse score between the two groups (P 0.05). 3. Arterial blood at the end of one-lung ventilation in BBs group and DLT group.There was no significant difference in gas results between PHO 2 and Paco 2 (P 0 05. 4).The levels of TNF- 偽 IL-6 and IL-8 in alveolar lavage fluid in BBs group were significantly lower than those in DLT group (both the incidence of postoperative pharynx in P0.05).5.BBs group was significantly lower than that in DLT group (P 0.05), but there was no significant difference between the two groups in the incidence of hoarseness and pulmonary complications (both P0.05).Conclusion 1.In radical resection of esophageal cancer, the bronchial occluder has the advantages of lower airway resistance, less influence of pulmonary inflammatory factors and lower incidence of pharynx pain after operation compared with double-lumen bronchial catheter.And the former lung collapse time is longer. 2.There was no significant difference between bronchial occluder and double lumen bronchial catheter on arterial blood gas, pulmonary atrophy score, hoarseness after operation and incidence of pulmonary complications.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614;R735.1

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