气道CT三维重建测量术在新生儿支气管封堵器放置中应用.docVIP

气道CT三维重建测量术在新生儿支气管封堵器放置中应用 　　[摘要] 目的 探?气道CT三维重建测量术在新生儿支气管封堵器放置中的应用。 方法 选择2015年1月～2016年9月在广州市妇女儿童医疗中心行限期胸科单肺手术新生儿28例作为研究对象，根据自愿选择支气管封堵器的放置方式，分为传统组和CT组。传统组采用手控呼吸阻力结合听诊定位的盲插法放置支气管封堵器，而CT组则在气道CT三维重建测量数据的指导下放置支气管封堵器。比较术前双肺通气时（T1）、单肺通气即刻（T2）、单肺通气10 min（T3）、肺萎陷后10 min（T4）4个时点两组患儿血氧饱和度（SpO2）、呼末二氧化碳（EtCO2）、血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）的变化情况。观察放置时定位时间、肺萎陷时间、肺萎陷质量、术中导管及支气管封堵器移位次数，以及术毕用纤支镜评估气道黏膜损伤情况。 结果 两组患儿T1时点SpO2、EtCO2、PaO2和PaCO2差异无统计学意义（P 0.05）；与传统组相比，CT组患儿在T2和T3时点SpO2、PaO2升高，EtCO2和PaCO2下降（P 0.05）。 结论 对于术中需行单肺通气的新生儿，术前通过螺旋CT气道重建分析，可对患儿气管情况进行更为全面准确地评估，进而实现安全高效地放置支气管封堵器。 　　[关键词] 支气管封堵器；新生儿；CT三维重建；单肺通气；纤维支气管镜 　　[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210（2017）09（a）-0077-04 　　[Abstract] Objective To explore the application of CT 3D reconstruction measurement in the placement of bronchial occlusive device in newborn′s air passage. Methods 28 cases of newborns underwent limited one-lung ventilation surgery in Guangzhou Women and Children Medical Center from January 2015 to September 2016 were selected as the subjects. They were randomly and evenly divided into the traditional group and CT group according to the placement mode of bronchial occlusive device. Bronchial occlusive device of the traditional group was placed in the blind-mate way namely with manual controlled breathing resistance combined with auscultation localization， while bronchial occlusive device of the CT group was placed guided by the CT 3D reconstruction measurement data. Two groups of children were compared for SpO2， EtCO2， PaO2 and PaCO2 at the time of double-lung ventilation （T1）， immediate one-lung ventilation （T2）， 10 min after one-lung ventilation （T3） and 10 min after pulmonary collapse （T4）. Localization time of placement， pulmonary collapse time， pulmonary collapse quality， intraoperative catheter and the shift times of bronchial occlusive device before the operation were observed and counted. Air passage mucosal damage was evaluated by fibreoptic bronchoscope after operation. Results There were no