The Application Of Different Lung Isolation Techniques During One-lung Ventilation In Thoracoscopic Surgery

Objective:To compare the effect of bronchial blocker and double-lumen tube on respiratory mechanics,intrapulmonary shunt and postoperative complications during one-lung ventilation in thoracoscopic surgery.Methods:60 patients undergoing thoracoscopic surgery were randomly divided into bronchial blocker group(group A,n=30)and double-lumen tube group(group B,n=30).All patients were given routine monitoring and invasive arterial pressure monitoring after entering the operating room.Endotracheal intubation assisted by video laryngoscope after routine anesthesia induction.Recorded the peak airway pressure(Ppeak)of the two groups after 20 minutes of two-lung ventilation(T1),20 minutes of one-lung ventilation(T2),60 minutes of one-lung ventilation(T3),and 20 minutes of two-lung ventilation(T4).Arterial blood gas analysis was performed after 20 minutes of two-lung ventilation(T1),20 minutes of one-lung ventilation(T2),60 minutes of one-lung ventilation(T3),and 20 minutes of two-lung ventilation(T4).Record into pulmonary shunt fraction(Qs/Qt),oxygenation index(OI)and respiratory index(RI).Observed the hoarseness and sore throat inl,2 and 3 days after surgery.Results:(1)Ppeak in T2 and T3 of the two groups were higher than that in T1,the Ppeak in T2 and T3 of the group B was higher than that in group A(P<0.05).There was no significant difference in Ppeak between the two groups in T1 and T4(P>0.05).(2)Qs/Qt in T2 and T3 of the two groups were higher than that in T1 and T4,T3 was higher than that in T2,the Qs/Qt in T2 and T3 of group B was higher than that in group A(P<0.05).The trend of Qs/Qt over time in A and B groups were T3>T2>T4>T1.(3)Group B had lower OI than group A at T2 and T3(P<0.05).In B group,OI decreased compared with T2 at T3,and the difference was statistically significant(P<0.05).In A group,there was no significant difference in OI between T2 and T3(P>0.05).(4)RI was higher in T2,T3 than in T1 and T4 of both groups(P<0.05).The RI of group B at T2 and T3 was higher than that of group A(P<0.05).In the group B,RI increased in T3 compared with T2,the difference was significant(P<0.05).There was no significant difference in RI of group A at T2 and T3(P>0.05).There was no significant difference in RI between the two groups at T4(P>0.05).(5)There was no significant difference in the incidence of hoarseness and sore throat between the two groups on the first,second and third day after surgery(P>0.05).Conclusion:There is no significant difference in airway injury between different lung isolation techniques in thoracoscopic surgery.However,compared with double lumen tube,bronchial blocker during one lung ventilation can effectively reduce peak airway pressure,improve lung compliance,reduce intrapulmonary shunt,improve oxygenation function and reduce lung function injury.