The Effect Of Pulmonary Ultrasound In Bronchial Blocking One-lung Ventilation On Judging Lung Isolation

Objective:To explore the effect of pulmonary ultrasound in bronchial blocking one-lung ventilation(OLV)on judging lung isolation.Methods:Sixty patients underwent general anesthesia with left bronchial closure for left lung cancer were enrolled,The ratio of male to female was 1:1.Patients were randomly divided into 3 groups,n=20.Auscultation group:Bronchus occluder was inserted after single-chamber endotracheal intubation,and the gas injected into the capsule,the lungs were isolated and auscultated with a stethoscope;fiberoptic bronchoscopy group:Bronchus occluder was inserted after single-chamber endotracheal intubation,and the gas injected into the capsule,pulmonary bronchoscopy was used to confirm lung isolation;ultrasound group:Bronchus occluder was inserted after single-chamber endotracheal intubation,and the gas injected into the capsule,lung ultrasound was used to confirm lung isolation.The lung isolation judgment time,lung collapse satisfaction and the number of adjustments of intraoperative occluder cuff positionwere compared between the three groups,meanwhile,HR,MAP and CVP changes at the time point of before induction,after induction,localization,skin cutting,OLV,OLV for 30 min,and TLV recovery,Airway peak pressure,airway platform pressure and lung compliance at the time of induction,cuticle,OLV time,OLV 30 min and TLV time,and the blood gas at pre-induction,post-induction,OLV time,OLV 30 min,TLV recovery and postoperative in the three groupswere compared.Results:The time of lung isolation in fiberoptic bronchoscopy group and the ultrasound group was shorter than that of the auscultation group,the difference was statistically significant(P<0.05 or P<0.01),and there was no significant difference between the fiberoptic bronchoscopy group and the ultrasound group(P>0.05).The satisfaction of lung collapse in the fiberoptic bronchoscopy group and the ultrasound group was higher than that in the auscultation group,the difference was statistically significant(P<0.01 or P<0.001),and there was no significant difference between the fiberoptic bronchoscopy group and the ultrasound group(P>0.05).The number of intraoperative cuff position adjustments in the bronchoscopy group and the ultrasound group were less than that in the auscultation group,the difference was statistically significant(P<0.001),and there was no significant difference between the fiberoptic bronchoscopy group and the ultrasound group(P>0.05).In the comparison of hemodynamics between the three groups,the HR and MAP of judging the lung isolation in the fiberoptic bronchoscopy group were higher than that before induction,the difference was statistically significant(P<0.05).At the same time,the HR and MAP of judging the lung isolation in the auscultation group and the ultrasound group were lower than that in the fiberoptic bronchoscopy group,the difference was statistically significant(P<0.01 or P<0.001).In the comparison of respiratory parameters of the three groups,the lung compliance at 30 minutes of OLV was lower than that after induction in all three groups,the difference was statistically significant(P<0.001),and there was no significant difference between the groups(P>0.05).In the comparison of blood gas in three groups,PaO2at the time of after induction,OLV,OLV 30 min,lung ventilation(TLV)and after surgery was significantly increased than before induction,the difference was statistically significant(P<0.001).Conclusions:Pulmonary ultrasound used to judge the effect of OLV lung isolation was better than auscultation,its effect was similar to that of fiberoptic bronchoscopy,and the effect of ultrasound group on hemodynamics was smaller than that of fiberoptic bronchoscopy group.