纤维支气管镜在新生儿支气管封堵器放置中的应用.docVIP

纤维支气管镜在新生儿支气管封堵器放置中的应用 　　[摘要] 目的 探讨纤维支气管镜（FOB）用于指导新生儿支气管封堵器（BB）放置的有效性和安全性。 方法 选择于2014年1月～2015年12月期间广州市妇女儿童医疗中心需以支气管封堵器术中行单肺通气的择期胸科手术的患儿60例为研究对象，按照手术方式的不同分为A组和B组，每组30例。全部患儿均先行气管插管，A组通过气管导管置入纤维支气管镜评估患儿气道情况，然后拔出纤维支气管镜，根据评估结果以听诊定位盲插法放置BB；B组直接采用听诊定位盲插法放置BB。记录两组BB放置前，放置后即刻、5 min和10 min 4个时点的平均动脉压、心率、血氧饱和度、呼末二氧化碳和乳酸水平，比较两组BB定位时间、BB放置尝试次数、术中BB移位次数、术中肺萎陷情况、手术时间、出血量、拔管时间和术后气道黏膜损伤情况。所得数据采用统计学软件SPSS 17.0建模处理。 结果 两组各时点平均动脉压、心率、血氧饱和度、呼末二氧化碳和乳酸水平比较，差异均无统计学意义（P 0.05）；两组BB定位时间、手术时间、出血量和肺萎陷情况比较，差异均无统计学意义（P 0.05）；与B组比较，A组BB放置尝试次数和移位次数少、拔管早、术后气道黏膜损伤，差异均有统计学意义（P 0.05）。 结论 临床上应用纤维支气管镜指导新生儿支气管封堵器放置具有较高的有效性和安全性，值得进一步优化推广。 　　[关键词] 纤维支气管镜； 支气管封堵器；新生儿 　　[中图分类号] R768.1 [文献标识码] A [文章编号] 1673-7210（2016）08（b）-0142-04 　　[Abstract] Objective To study the effectiveness and safety of FOB guiding BB placement in newborn. Methods 60 one-lung ventilation patients under elective thoracic surgery in Guangzhou Women and Childrens Medical Center between January 2014 and December 2015 were selected as research objects and were divided into group A （30 cases） and group B （30 cases）. Tracheal intubation was performed on all patients. Airway condition of patients in group A was evaluated by placing FOB through the endotracheal tube and BB was placed by auscultation positioning blind intubation combined with evaluation results after FOB was pulling out. BB was placed on group B by auscultation positioning blind intubation. Mean arterial pressure， heart rate， blood oxygen saturation （SpO2）， end-tidal CO2 （EtCO2） and lactic acid level of the two groups before placing BB and immediate， 5 min， 10 min， after placing BB were recorded. BB positioning time， trial times of BB placement， atelectasis in operation， operation time， blood loss， extubation time， airway mucosa injury after operation of the two groups were compared. All the data was modeled and analyzed by statistical software SPSS 19.0. Results Mean arterial pressure， heart rate， blood oxygen saturation （SpO2）， end-tidal CO2 （EtCO2） and lactic acid l