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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 预览

Application of CT 3D reconstruction measurement in the placement of bronchial occlusive device in newborn's air passage
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摘要 目的探讨气道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10min(T3)、肺萎陷后10min(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)。与传统组相比,CT组定位时间和肺萎陷时间缩短,肺萎陷质量提高,气道黏膜损伤程度降低,差异均有统计学意义(P〈0.05);两组术中导管及支气管封堵器移位次数差异无统计学意义(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。 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 PaC02 at the time of double-lung ventilation (TI), immediate one- lung ventilation (T2), 10 rain 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 bronehoscope after operation. Results There were no statistical differences between two groups of children in SpO2, EtCO2, PaO2 and PaCO2 at T1 (P 〉 0.05). Compared with the traditional group, SpO2 and PaO2 increased at T2 and T3, while EtCO2 and PaCO2 decreased in CT group (P 〈 0.05). Compared with the traditional group, localization time and pulmonary collapse time were decreased, pulmonary collapse quality was improved, mucosal damage was decreased in and air passage CT group (P 〈0.05). There was no statistical difference between the two groups in the number of intraoperative catheter and shift times of bronchial occlusive device (P 〉 0.05). Conclusion Preoperative spiral CT airway reconstruction and analysis for the newborns who
作者 徐颖怡 宋兴荣 谭永红 刘威 潘永英 XU Yingyi SONG Xingrong TAN Yonghong LIU Wei PAN Yongying (Department of Anesthesiology, Guangzhou Women and Children Medical Center, Guangdong Province, Guangzhou 510120, China)
出处 《中国医药导报》 CAS 2017年第25期77-80,共4页 China Medical Herald
基金 广东省广州市医药卫生科技项目(20151A010039).
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 Bronchial occlusive device Newborn CT 3D reconstruction One-lung ventilation Fibreoptic bronchoscope
作者简介 徐颖怡(1982.3-),女,硕士;研究方向:小儿麻醉及气道管理。
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