Study On Application Of Bronchial Blockers In One-lung Ventilation In Thoracoscopic Lobectomy

Objective: Lung cancer is a common cancer of the residents in our country,the incidence rate of 48.90/10 million,accounting for 18.39% of all new cancer cases,surgery is the main treatment.Thoracoscopic surgery(VAS)with less damage,wide operation,the advantages of fast postoperative recovery,has been widely carried out in clinical.The key of VAS is to lung isolation and one-lung ventilation.In the thoracic surgery often need to use One-lung ventilation because that way can make two lungs isolation,and the contralateral lung isn?t pollunted,it could also maintaint a good surgial exposure.Double-Lumen Tube is widely used in clinical,but it?s intubation and location is very difficult,that may injure airway epithelial cell easily.In recent years,Bronchial Blockers is used more and more because that more simply.This investigate is aimed to investigate the bronchial blocker(BB)application in the safety and feasibility of thoracoscopic lobectomy in.Methods: The Study is a randomized controlled study,it was initially provided by the Ethics Committee of the Forth hospital of Hebei Medical University.This issue is a randomized,double-blind,controlled,prospective study and registered in the center of the clinical trials.The 80 patients were randomized to receive a DLT or BB alone(n=40).Inclusion criteria were as follows:All of these patients were aged from 45 to 70 years old;American Society of Anesthesiologists(ASA)physical status between ?and ?.Their BMIs were between 20-25 kg/m2 and they were all with a normal cardiop-ulmonary function.They did not have a chemotherapy or radiotherapy history.After they entered the operation room,an upper limb venous access was founded.The electrocardiogram(ECG),saturation of blood oxygen(Sp O2)and BIS were monitored with the Philips Intelli Vue MP50 multifunctional monitor.The radial artery and internal jugular venous puncture were proceeded under local anesthesia,so the continuous arterial pressure and CVP could be monitored.the patients were given with Atropine 0.5mg and midazolam 0.05mg/kg.Then the patients would be anesthetized by a vein rapid induction proceeded by sufentanil(0.5-0.7?g/kg),etomidate(0.2-0.4mg/kg)and cisatracurium(0.3mg/kg).The DLT group a Double-Lumen Tube was inserted into the target bronchus,and the patients of BB would be intubated with a single-lumen endotracheal tube(8.0# for male patients and 7.5# for female patients)and Bronchial Blocker by the same anesthetist with rich experience in about 3 minutes.Fiberoptic bronchoscopy was essential for examining if the endobronchial blocker was correctly positioned.During the maintenance of anesthesia,remifentanil(0.5-1?g/kg/min)and sevolurance(1.5-3.0%),to keep a BIS(Bispectral Index)value of40-60.In order to maintain muscle relaxation,cisatracurium of 0.05mg/kg was givene every 15-30 minutes.All patients were ventilated with Datex-Ohmeda7100 anaesthesia machine,commenced with an 80%O2,gas flow 1L/min.When double-lumen ventilation,the tidal volume is 6-8ml/kg,Inspiration time/expiratory time(I:E)1:2 and the rate is 11-13 times/min so that adjust to maintain an end-tidal CO2 concentration between35-40 mmhg.When one-lumen ventilation,tidal volume is 5-7ml/kg,the rate is about 14-15times/min and make the end-tidal CO2 concentration between35-40 mmhg.Intraoperative fluid,Ringer's acetate and sodium chloride hydroxyethyl starch injection of 200/0.5 liquid crystal gel ratio Ratio of 2:1 infusion to maintain intraoperative CVP lateral position in 8-10 cm H2O,urine volume is more than1ml/kg/min.Before closed chest the BB group can be pulled out the suction tube to attract airway secretions of the Blocker,DLT group were treated with two suction tubes on both sides of lumen and airway secretions.After fiberoptic bronchoscopy,there was no residual airway in the two groups,and then make up the lung.The two groups were connected PCIA analgesia pump in half an hour before the postoperative(dezocine 0.5mg/kg+ propacetamol2g+ right dexmedetomidine 120?g).1 Record observation index1.1 Routine anesthesia records: the patient's general condition(age,height, weight),intraoperative fluid volume and urine volume.1.2 Observation index: the patient into the pulse oxygen saturation(Sp O2),arterial oxygen pressure(Pa O2),anesthesia machine control peak airway pressure ventilation of double lung ventilation,pulse oxygen saturation(Sp O2),the peak airway pressure(Ppeak),arterial oxygen pressure(Pa O2)of one lung ventilation 30 minutes,and Alveolar arterial oxygen pressure difference(A-a DO2),oxygen index(Pa O2/Fi O2),two groups of single lung appeared the lowest oxygen saturation.2 Patients were followed up: the body temperature and postoperative white blood cells,the incidence of pneumonia,hospitalization time and costs.Results:1 Intraoperative1.1 Double lung ventilation(DLV)of the peak peak airway pressure bronchial blockers(BB)and double lumen endotracheal intubation(DLT)groups showed no significant difference(P>0.005);the peak airway pressure of bronchial blockers(BB)during one lung ventilation(OLV)and double lumen bronchial intubation(DLT)groups is significantly different(P<0.05);the peak airway pressure of bronchial blocker is lower than double lumen endotracheal intubation.1.2 Arterial partial pressure of oxygen and oxygen index(Pa O2/Fi O2)of one lung ventilation(OLV)of bronchial blockers(BB)group in 30 min is higher than that of double lumen endotracheal intubation(DLT)group(P<0.05).1.3 Difference of alveoli-arterial oxygen pressure of double lumen endotracheal intubation(DLT)group when only lung ventilation half an hour was higher than that of the bronchial blocker(BB)group.1.4 The rate of hypoxemia was higher in the double lumen endobronchial tube group than in the bronchial blocker group,with Sp O2 less than 92 and over 20 seconds longer as hypoxemia.1.5 There was no significant difference in operation time between the two groups.2 Postoperative There was no significant difference about body temperature and posto-perative WBC,incidence of pneumonia,hospitalization time and cost.Conclusion:The Bronchial blockers during one-lung ventilation airway peak pressure is relatively low,is conducive to improve oxygenation,does not increase the incidence of postoperative pneumonia.Intraoperative ipsilateral lung collapse satisfactory[16],and not to increase the difficulty of exposure,does not affect the surgery operation.Bronchial blockers in thoracoscopic lobectomy is safe to surgery and effectively completed one lung ventilation,one lung ventilation method is to meet the thoracoscopic operation well.