2026 年第 9 期 第 21 卷

喉罩联合支气管封堵器对胸腔镜肺切除术患者术后肺部并发症的影响

Effects of laryngeal mask airway combined with bronchial blocker on postoperative pulmonary complications in patients undergoing thoracoscopic pulmonary resection

作者：李义1孟磊1李冲1张倩2

英文作者：Li Yi1 Meng Lei1 Li Chong1 Zhang Qian2

单位：1河北省人民医院麻醉科，石家庄050051；2河北医科大学第四医院重症医学科，石家庄050051

英文单位：1Department of Anesthesiology Hebei General Hospital Shijiazhuang 050051 China; 2Department of Critical Care Medicine The Fourth Hospital of Hebei Medical University Shijiazhuang 050051 China

关键词：肺部并发症；喉罩；支气管封堵器；胸腔镜；单肺通气

英文关键词：Pulmonarycomplications;Laryngealmaskairway;Bronchialblocker;Thoracoscopy;One-lungventilation  

• 摘要：

• 目的 评价喉罩联合支气管封堵器对胸腔镜肺切除术患者术后肺部并发症（PPCs）的影响。方法 选择2024年1—3月河北省人民医院收治的择期全身麻醉下行胸腔镜下肺切除术患者176例。采用随机数字表法分为E组和L组，每组88例。E组手术过程中采用气管插管联合支气管封堵器实施单肺通气，L组手术过程中采用喉罩联合支气管封堵器实施单肺通气。记录并比较2组患者术后7 d内PPCs的发生情况，术前1 d和术后1 d血细胞计数和15项恢复质量评分量表(QoR-15)评分，术后引流管的拔管时间与住院时间。结果 L组和E组各PPCs及PPCs总发生率［总发生率：28.4%（25/88）比39.8%（35/88）］比较差异均无统计学意义（均P>0.05）。2组术前1 d、术后1 d白细胞计数、中性粒细胞计数及淋巴细胞计数比较差异均无统计学意义（均P＞0.05）。术后1 d，2组QoR-15评分均低于术前1 d，但L组高于E组［（119±5）分比（108±6）分］（t=11.531，P<0.001）。L组引流管拔管时间及住院时间显著短于E组［3（2,3）d比3（2,4）d、4（4,5）d比5（4,7）d］（均P<0.05）。结论 在胸腔镜手术中，采用喉罩联合支气管封堵器与气管插管联合支气管封堵器的气道管理方案，在降低术后7 d内肺部并发症的发生率方面效果相当，但喉罩联合支气管封堵器方案能有效提升患者术后早期恢复质量，缩短引流管留置时间及住院时间。

• Objective To evaluate the effects of laryngeal mask airway combined with bronchial blocker on postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic pulmonary resection. Methods A total of 176 patients scheduled for elective thoracoscopic pulmonary resection under general anesthesia admitted to Hebei General Hospital from January to March 2024 were selected and divided into group E and group L by random number table method, with 88 patients in each group. Group E received one-lung ventilation via endotracheal intubation combined with bronchial blocker during operation, while group L received one-lung ventilation via laryngeal mask airway combined with bronchial blocker. The incidence of PPCs within 7 d after surgery, blood cell counts 1 d before and 1 day after operation, the scores of 15-item quality of recovery questionnaire (QoR-15), postoperative drainage tube removal time and hospital stay were recorded and compared between the two groups. Results There were no statistically significant differences in the incidence of each single PPC and the total incidence of PPCs ［total incidence: 28.4%(25/88) vs 39.8%(35/88)］ between group L and group E (all P>0.05). No significant intergroup differences were observed in white blood cell count, neutrophil count and lymphocyte count at 1 day before and 1 day after operation (all P>0.05). The QoR-15 scores of both groups at postoperative day 1 were lower than those at preoperative day 1, while group L had higher scores than group E ［(119±5) vs (108±6)］(t=11.531, P<0.001). The drainage tube removal time and hospital stay in group L were significantly shorter than those in group E ［3(2,3)d vs 3(2,4)d, 4(4,5)d vs 5(4,7)d］(both P<0.05). Conclusions For thoracoscopic surgery, airway management with laryngeal mask airway combined with bronchial blocker yields comparable efficacy in reducing the incidence of PPCs within 7 d after operation compared with endotracheal intubation combined with bronchial blocker. Nevertheless, the regimen of laryngeal mask airway combined with bronchial blocker can effectively improve the early postoperative recovery quality and shorten drainage tube indwelling time and hospital stay.