| Objective: Observe the displacement of bronchial blocker in thoracoscopic lung tumor resection,to find out the factors affecting the displacement of bronchial blocker,in order to guide clinical work.Method: Selected patients who underwent selective thoracoscopic lobectomy from May 2018 to October 2018 in our hospital and underwent bronchial occlusion for one-lung ventilation.Patients who met the inclusion and exclusion criteria were selected during the preoperative visit,and their age,gender,height and weight were recorded.The operation mode and the time of one-lung ventilation were recorded,and the initial direction of Tampa angle was recorded.After the displacement of the bronchial blocker was observed,it was confirmed by fiberoptic bronchoscopy,and the recovery was adjusted immediately.It was recorded the ongoing operation while displacement occured.Data that do not meet the requirements will be eliminated according to the exclusion criteria.Univariate and multivariate logistic regression analysis was used to analyze the valid data.The factors which P < 0.2 in univariate regression analysis was included in multivariate regression analysis.The factors which P < 0.05 in multivariate analysis was considered to have statistical significance.Criteria for judging displacement: when pulmonary inflation occurs during one-lung ventilation,it affects the operation,or when airway pressure rises sharply,it is necessary to intervene.That is to say,the displacement of bronchial blocker occurs.Result:1.General information of patients: A total of 168 patients were observed in this study.The age was 60(53,67)years old,height was(162.75±7.61)cm,body weight was(64.94±11.13)kg,BMI was(24.47±3.58)kg/m2,single lung ventilation time was(2.37 ± 0.92)h,sex ratio(male / female)was 84:84.The direction of the Tampa angle was 116(69%)toward the cartilage ring,and 52(31%)toward the membrane.70 patients(41.7%)underwent left lung surgery,including 36 cases(21.4%)with left upper lobe resection,26 cases(15.5%)with left lower lobe resection,and 8 cases(4.8%)with left total pneumonectomy;right lung 98 patients(58.3%)underwent surgery,including 52(31.0%)patients with right upper lobe resection,10 patients(6.0%)with right middle lobe resection,and 36 patients(21.3%)with right lower lobe resection.2.Univariate regression analysis was performed after assigning possible factors(gender,age,BMI,surgical procedure,single lung ventilation time,Tampa angle orientation),and the single lung ventilation time(P = 0.073)and Tampa angle orientation(P = 0.002)were obtained.They are the factors that affect the shift in BB.Including(single lung ventilation time,Tampa angle orientation)into multivariate regression analysis showed that single lung ventilation time ≥ 2h(P=0.003),Tampa angle pointing to the cartilage ring(P=0.000)can significantly affect the displacement of the bronchial blocker(P<0.05),the OR value(95% confidence interval)were 0.183(0.060-0.557)and 0.198(0.084-0.469),respectively.3.There were 61 cases that occurred shift,and the displacement rate was 36.3%.The operating procedure while shifting were mainly divided into the following four cases: 10 cases(16.4%)of free and disconnected blood vessels,11 cases(18.0%)of free and disconnected trachea,and 32 cases(52.5%)of resection of the seventh group of lymph nodes.The other 8 cases(13.1%).Conclusion: The displacement rate of bronchial blocker is high.The single lung ventilation time ≥2h and the Tampa angle pointing to the cartilage ring can significantly affect the intraoperative BB displacement.More than 50% of the displacement occurs the seventh group of Lymph nodes dissection. |
