The Effect Of Closed Bronchial Occlude Technique On Lung Collapse In Thoracoscopy Patients

Objective:To investigate the effects of closed bronchial occlude technique on the time of intraoperative lung collapse,quality of lung collapse,hemodynamics,blood gas analysis indexes,and perioperative complications in patients undergoing thoracoscopic surgery（VATS）,and comprehensively evaluate the effectiveness and safety of this technique.Method:This study was a prospective,double-blind,randomized controlled trial.Fifty patients aged 18-70 years,BMI 18-25 years,estimated operation time>2 hours,ASA grade I to III,and undergoing selective double-lumen bronchial intubation under general anesthesia were divided into control group（group C）and blocking group（group O）,with 25 patients in each group.In both groups,one-lung ventilation（OLV）was implemented immediately after the lateral decubitus position was confirmed and the tracheal catheter position was correct.In group C,the operative bronchial lumen was opened to air during OLV,while in group O,the operative bronchial lumen was kept closed.Intraoperative observation and recording of pleural opening（AP）to satisfactory lung collapse（lung collapse score:8）and surgeon satisfaction score,Postoperative video review clips of pleural opening 1min（S0）,pleural opening 5min（S1）,pleural opening 10min（S2）,pleural opening 20min（S3）,pleural opening 30min（S4）and pleural opening 40min（S5）were performed to score the quality of lung collapse.MAP and HR changes were recorded before induction（T0）,10min after intubation（T1）,5min after single lung ventilation（T2）,5min after pleural opening（T3）,5min after thoracic closure（T4）,after surgery（T5）and 10min after extubation（T6）.The changes of Pa O₂ and Pa CO₂ were recorded at 10min after intubation（T1）,5min after single lung ventilation（T2）,5min after pleural opening（T3）and 10min after extubation（T6）.Surgical information,intraoperative complications,vasoactive drugs,postoperative recovery indexes and pulmonary complications of the two groups were recorded.Result:A total of 49 patients（25 in group C and 24 in group O）completed the trial and were eventually included in the statistical analysis.Preoperative baseline data such as age,gender,BMI,ASA grading,FEV1%,FEV1/FVC%and DLCO%were compared between the two groups,and there was no significant difference（P>0.05）.There was no significant difference in the type,operation side,operation type,operation time,blood loss,urine volume and infusion volume between the two groups（P>0.05）;The OLV to AP duration of group O and group C was（15.88±4.99）min vs（16.45±4.27）min,and the difference was not statistically significant.The satisfactory lung collapse time of group O was12.0（9.0-13.0）min,which was significantly lower than that of group C17.0（14.0-20.5）min,and the difference was statistically significant.Compared with group C,patients in group O had higher satisfaction,and the difference was statistically significant（P<0.05）.Compared with group C,the scores of lung collapse quality in group O at S0,S1,S2 and S3 were significantly higher,and the difference was statistically significant（P<0.05）.There was no significant difference in lung collapse quality scores at S4 and S5 time points（P>0.05）.Comparison of MAP at each time point between the two groups:Compared with T0,the MAP at T2 and T3 decreased significantly（P<0.05）,but there was no significant difference at T1,T4～T6（P>0.05）;Compared with group C,there was no significant difference in MAP of group O patients at each time point of T0～T5（P>0.05）.Comparison of HR at each time point between the two groups:Compared with T0,HR at T6 was significantly increased between the two groups（P<0.05）,and HR at T1-T5 was not significantly different（P>0.05）;Compared with group C,there was no significant difference in HR in group O at T0～T5 time points（P>0.05）.Comparison of Pa O₂ at each time point between the two groups:Compared with T1,Pa O₂ at T2 and T3 decreased significantly in both groups（P<0.05）;Compared with group C,Pa O₂ in group O at T2 was significantly increased,but the difference was not statistically significant（P>0.05）;There was no significant difference in Pa O₂ at T1,T3 and T6（P>0.05）.There was no statistical significance in Pa CO₂ between the two groups at T1,T2,T3 and T6 time points（P>0.05）.There was no statistical significance in the use of vasoactive drugs between the two groups（P>0.05）.There was no significant difference in intraoperative complications such as hypoxemia between the two groups（P>0.05）.Postoperative tracheal extubation time,SICU residence time,discharge time and postoperative pulmonary complications such as hypoxemia,pneumonia,atractasis,pneumothorax and pleural effusion were compared between the two groups,and there was no statistical significance（P>0.05）.Conclusion:1.For patients undergoing thoracoscopic surgery with double lumen bronchial intubation and single lung ventilation,closed bronchial occlude technique can accelerate the speed of intraoperative lung collapse and improve the quality of lung collapse at the early stage of pleural opening;2.Closed bronchial occlude technique has little influence on intraoperative hemodynamics,blood gas analysis indexes,intraoperative and postoperative complications,and can be safely and effectively used in patients undergoing thoracoscopic surgery.