通过选择性支气管插管进行单肺通气或孤立肺通气技术在儿科的应用

Selective bronchial intubation for one-lung ventilation and independent-lung ventilation in pediatric age: state of the art

摘要:

重症监护、全麻或术后的儿科患者是有可能需要进行单肺通气（one-lung ventilation）或孤立肺通气（independent-lung ventilation）的。该技术在儿科，特别是6~8岁以下患儿中的应用最主要困难是缺乏合适的双腔导管（double-lumen tube）。支气管封堵器（bronchial blocker）或常规单腔管都被尝试用来给婴儿或幼童进行选择性支气管插管（selectivebronchial intubation）和单肺通气。封堵器和单腔导管的主要缺陷是无法完全密封，需要中断通气的这侧肺不容易萎陷和再次复张，治疗过程中容易异位，常需要纤维支气管镜来引导操作。

Abstract:

Selective bronchial intubation (SBI) to ventilate a single lung (one-lung ventilation, OLV) or to apply separate lung ventilation (independent-lung ventilation, ILV) can be frequently required under general anesthesia in pediatrics, mainly in video assisted thoracoscopy surgery, in the postoperative care of cardio-thoracic surgery, and for the treatment of lung pathologies with unilateral prevalence in intensive care. In children over 6-8 years of age SBI, OLV and ILV can be performed using marketed double-lumen tubes (DLTs). In neonates, infants and younger children the application of ILV is limited due to the lack of DLTs. For children of this age, a specific DLT for ILV was developed (Marraro Paediatric Endobronchial Bilumen Tube^®) but is currently available only as a special product. The DLT represents the device of choice for OLV and ILV while the use of bronchial blocker is suggested as an alternative to achieve the SBI and the OLV when suitable DLTs are not available. Different catheters types can be used as bronchial blocker. If SBI is not possible using DLT or bronchial blocker, a conventional single-lumen tube of adequate length can allow SBI in all pediatric ages. Using the bronchial blocker and single lumen tube it is possible to perform OLV but it is impossible to apply ILV. The main complications of SBI and DLT are largely due to limited operator experience. Airway trauma, dislodgment and obstruction of the devices are quite frequent and can lead to severe hypoxia if not recognized and treated early.