支气管封堵器的临床应用.ppt

1、支气管封堵器的支气管封堵器的临床床应用用赵雪雪莲河北医科大学第四医院河北医科大学第四医院支气管封堵器支气管封堵器-中国知网中国知网期刊期刊国内会国内会议议 研究生研究生论论文文 国国际际会会议议010203040506070篇数篇数篇数76；2003-2018支气管封堵器支气管封堵器-中国知网中国知网 2005 2010 2015 20180510152025303540篇数篇数篇数Bronchial Blocker(BB)PubMedlClinicalTrial281996 20181 1/y yBronchial Blocker(BB)PubMedlCaseReport103人人-102；

2、动物；动物-1。19832018CaseReport 1990 1995 2000 2005 20102015 20180510152025303540篇数篇数篇数BBBB 始于始于1936，Magill 在胸科手术中使用末端带气囊的长在胸科手术中使用末端带气囊的长管封堵支气管，后改进与单腔气管导管配合使用。（带套管封堵支气管，后改进与单腔气管导管配合使用。（带套囊尿管）囊尿管）现现 BB 不断有新品面世。不断有新品面世。BB类型类型Arndt BBCohen BBTCB Univent BBFuji BBE Z BB Coopdech BBBB：困难气道DLT 的板凳队员Onelungven

3、tilationincaseswithunsuccessful double-lumen endobronchial intubation.1993ChinesejournalofanesthesiologyIndependentplacementofabronchialblockerforsingle-lungventilation:analternativemethodforthe difficult airway.1996Anesthesia&AnalgesiaUseoftheUniventSystemtubefordifficult intubationandforachievingo

4、ne-lunganaesthesia.1996ActaAnaesthesiologicaScandinavicaLungisolationtechniquesforpatientswithdifficult airway.2010CurrentopinioninanaesthesiologyOne-lungventilationinapatientwithstentingfortracheobronchial stenosis causedbyesophageal cancer.2011JournalofClinicalAnesthesiaUseoftheCoopdechBronchialBl

5、ockerasatrachealtubeintroducerinapatientwithdifficult laryngoscopy.2010JournalofClinicalAnesthesiaBB-小儿Anaestheticmanagementforaleftpneumonectomyin a child with bronchopleural fistula.2000 Pediatric Anesthesia Pediatric AnesthesiaOne-lunganesthesiawassuccessfullymaintainedbymeansofFogarty Catheter i

6、n infant.2002MasuiLungisolationin a child withunilateralnecrotizingClostridiumperfringenspneumonia.2005criticalcaremedicineCasereportofusingaconnector(phyconTCBbronchialblocker)forpediatric one-lung anesthesia.2007MasuiSinglelungventilationina young child forrepairofcoarctationofaorta.2 2010Journalo

7、ftheCollegeofPhysiciansandSurgeons-PakistanAlternativemethodsoflungisolationincasesofpediatric bilateralthoracoscopicsurgery .2016Pediatric AnesthesiaPediatric AnesthesiaBB-常规应用（单肺通气）BronchialBlockerVersusLeftDouble-LumenEndotrachealTubeforOne-Lung Ventilation inRightVideo-AssistedThoracoscopicSurge

8、ry.2018JournalofCardiothoracicandVascularAnesthesiaLung Isolation forThoracicSurgery:FromInceptiontoEvidence-Based.2017Review JournalofCardiothoracicandVascularAnesthesiaAComparisonoftheEfficacyandAdverseEffectsofDouble-LumenEndobronchialTubesandBronchialBlockersinThoracicSurgery:A Systematic Review

9、 andMeta-analysisofRandomizedControlledTrials.2015JournalofCardiothoracicandVascularAnesthesiaAnupdateonbronchialblockersduringlungseparationtechniquesinadults.2003Anesthesia&AnalgesiaBB-肺叶，肺段隔离肺叶，肺段隔离Segmental Lung Isolation inaPostpneumonectomyPatientUndergoingContralateralLungResection.2017Journa

10、lofCardiothoracicandVascularAnesthesiaLungisolationinpatientswithpreviouslungresections:Selectivesequentiallobar blockade usingaFujiUniblockerendobronchialblocker.2016RevistaEspaoladeAnestesiologayReanimacinUpdateonselectivelobar blockade duringpulmonaryresections.2009CurrentOpinioninAnesthesiologyS

11、equentiallobar-lung-lobar isolation usingadeflectingtipbronchialblocker.2006JournalofclinicalanesthesiaAProspectiveComparisonofIntraluminal and Extraluminal Placementofthe9-FrenchArndtBronchialBlockerinAdultThoracicSurgeryPatients.2017Journal of Cardiothoracic and Vascular AnesthesiaJournal of Cardi

12、othoracic and Vascular Anesthesial成人胸外科患者成人胸外科患者9-FArndt支气管阻支气管阻封堵器封堵器腔内和腔外腔内和腔外置入置入的前瞻性比较的前瞻性比较。腔外腔外方法方法放置的时间显著放置的时间显著缩短缩短，术后喉咙痛术后喉咙痛的发生率没有任何差异的发生率没有任何差异。无论无论是在腔内还是在腔外是在腔内还是在腔外，大部分大部分支气管内阻滞支气管内阻滞器器至少需要一次术至少需要一次术中重新定位。中重新定位。BB-用于气管出血止血用于气管出血止血Useofbronchialblockerinemergentthoracotomyinpresenceofupp

13、er airway hemorrhage,andcervical spine fracture:adifficultdecision.2018RevistaBrasileiradeAnestesiologiaExperienceofhemostasisintracheal bleeding veryclosetothecarinabythebronchialblocker:acasereport.2016KoreanJournalofAnesthesiologySuccessfulmanagementofatraumapatientwithpulmonaryhemorrhageusingawi

14、re-guidedbronchialblocker.2007TheJournalofTrauma:Injury,Infection,andCriticalCare.BB-用于阻断用于阻断单侧肺漏气肺漏气Managementoftraumaticpneumothoraxwithmassive air leakage:roleofabronchialblocker:acasereport.2014KoreanJournalofAnesthesiologyBB治治疗肺血栓取栓肺血栓取栓术后大咯血后大咯血ManagementofMassive Hemoptysis AfterPulmonaryThro

15、mboembolectomyUsingaDoubleBronchialBlockerSystem.2017JournalofCardiothoracicandVascularAnesthesiaBB-支气管残端瘘支气管残端瘘Twosuccessfulcasesinthetreatmentofpost-operative bronchial stump fistulae.2005AnnalsofThoracicandCardiovascularSurgeryBB-气管切开后置入气管切开后置入单肺通气肺通气ExtraluminalPlacementofanArndtBronchialBlocker

16、ThroughaTracheal Stoma.2016JournalofCardiothoracicandVascularAnesthesiaExsanguinatingtuberculosis-relatedhemoptysis:bronchialblockerintroducedthroughpercutaneous tracheostomy.2009MinervaAnestesiologicaFoleycatheterusedasbronchialblockerforonelungventilationinapatientwithtracheostomy-acasereport.1995

17、ActaanaesthesiologicaSinicaBB-病病态肥胖患者肥胖患者Lungseparationinthemorbidlyobesepatient.2012Anesthesiol Res PractBB-气道巨大气道巨大肿物物Successfulone-lungventilationusingabronchialblockertubefora large tracheal carcinoma resection.2017J Clin Anesth.DLT+BBDLT复合复合BB弥弥补DLT隔离不全隔离不全Failure of lung isolation byadouble-lu

18、menendotrachealtuberescuedbytheconcomitantuseofanarndtbronchialblockerunderdirectvisualization.2013A&ACaseReportsJournalDLT复合复合BB长期吸烟，气道分泌物多的肺叶切除期吸烟，气道分泌物多的肺叶切除AnestheticManagementofSimultaneousRightLobectomyandEsophagectomywithaDouble-lumenTrachealTubeandBronchialBlocker.2016MasuiDLT复合复合BB肺感染肺叶切除肺感

19、染肺叶切除Combinationofadouble-lumentrachealtubeandbronchialblockerforapatientwithcontinuousbleedingduetoinvasivelung infection.2015JournalofClinicalAnesthesiaDLT+BBDLT复合复合BB心外手心外手术气道出血气道出血Bronchialblockerversusdouble-lumentubeforlungisolationwithmassive hemoptysis duringcardiac surgery.2013JournalofCard

20、iothoracicandVascularAnesthesiaDLT复合复合BB肺毛霉菌病的肺毛霉菌病的单肺通气肺通气SuccessfulUseofaDoubleLumenEndotrachealTubeandBronchialBlockerforLungIsolationinPulmonaryMucormycosis.2018JournalofCardiothoracicandVascularAnesthesiaDLT复合复合BB-支气管胸膜瘘支气管胸膜瘘Lobarbronchialblockadeinbronchopleuralfistula.1992AnesthesiologyLM（la

21、ryngeal mask）+BBLM+BB-DLT失失败Differentiallungventilationusinglaryngealmaskairwayandabronchialblockertubeforapatientwithunanticipated difficult intubation.2007Masui.LM+BB气道气道肿物物Useoftheproseallaryngealmaskairwayandarndtbronchialblockerforlungseparationinapatientwithatracheal mass and aspiration risk.2

22、010JournalofCardiothoracicandVascularAnesthesiaLM+BB-气管切开气管切开Lungisolationusingalaryngealmaskairwayandabronchialblockerinapatientwitharecenttracheostomy.2008JournalofCardiothoracicandVascularAnesthesia不良事件BB尖端被切断尖端被切断TransectionofaCoopdech bronchial blocker tipduringbronchialresectionforright upper

23、lobectomy:acasereport.2015KoreanJournalofAnesthesiologyResectionoftheArndt Bronchial Blocker duringstaplerresectionoftheleft lower lobe.2006JournalofCardiothoracicandVascularAnesthesiaBB尖端扭尖端扭转ThetipfractureoftheCoopdech bronchial blocker duringinsertioninthepatientwithlungsurgery.2014KoreanJournalo

24、fAnesthesiologyBB尖端折断尖端折断AccidentalfractureofthetipoftheCoopdech bronchial blocker duringinsertionforonelungventilation.2010KoreanJournalofAnesthesiologyBB套囊破裂套囊破裂DifferentiallungventilationusingFogarty catheter afteraccidentaldamageofbronchialblockercuff.1999MasuiABallooningCrisis:ThreeCasesofBronc

25、hialBlockerMalfunctionandAReview.2017JournalofCardiothoracicandVascularAnesthesiaAvulsion of a bronchial blocker cuff inthetracheawhenusingaParkerFlex-Tipendotrachealtube。2010JCardiothoracVascAnesth.BB-肺肺污染染Casereport:pulmonary soiling afterone-lungventilationwithabronchialblocker.2002CanadianJourna

26、lofAnesthesiaBB低氧血症低氧血症Severehypoxemiaaftersuction of the nonventilated lung viathebronchialblockerlumenoftheunivent tube.1996JournalofCardiothoracicandVascularAnesthesiaBB-严重低氧血症重低氧血症Bronchialblockerforone-lungventilation：Aunanticipatedcomplication2011IndianJAnaesth气管支气管气管支气管-应用用BB失失败Congenitaltrac

27、healbronchus:theinabilitytoisolatetherightlungwithauniventbronchialblockertube.2000AnesthesiaandAnalgesiaRightupperlobetrachealbronchus:anestheticchallengeinone-lungventilatedpatients-Areportofthreecases-.2013KoreanJournalofAnesthesiology不良事件不良事件其他应用BB-取牙取牙Extractionofforeignbodywith2015RevistaEspao

28、ladeAnestesiologayReanimacinBB-高高频通气通气HighfrequencyjetventilationofonelungusingabronchialblockerofUniventduringcarinal resection.2010JournalofkoreanmedicalscienceHigh-frequencyjetventilationusingtheArndtbronchialblockerforrefractoryhypoxemiaduringone-lungventilationinamyasthenic patient with asthma.

29、2014JournalofclinicalanesthesiaBBCPAP联合改善低氧合改善低氧Continuous positive airway pressure appliedthroughabronchialblockerasatreatmentforhypoxemiaduetostenosisoftheleftmainbronchus.2009Anesthesiology其他其他应用用Gorham-Stout综合征：合征：TheGorham-Stoutsyndrome:onelungventilationwithabronchialblocker.AcaseofGorhamsdise

30、asewithchylothorax.2009 Pediatric AnesthesiaPediatric Anesthesia支气管支气管扩张性骨性骨软骨病骨病Managementofonelungventilationwithbronchialblockercatheterforapatientwithtracheobronchopathiaosteochondroplastica.2007Masui微微创CABGTheuseofabronchialblockercomparedwithadouble-lumentubeforsingle-lungventilationduringmini

31、mallyinvasivedirectcoronaryarterybypasssurgery.2002JCardiothoracVascAnesth.E-Z BBLungisolationusingEZ-Blockerbronchialblockinapatientduringabilateral endoscopicthoracicsympathectomy.2014RevistaEspaoladeAnestesiologayReanimacinSequentiallungisolationusingabronchialblocker(EZ-Blocker)forbilateraldorsa

32、lsympathectomy.2013JournalofClinicalAnesthesiaSequentialbilaterallungisolationwithasinglebronchialblocker.2013A&ACaseReportsJournalUseofBronchialBlockersforLungIsolation.2018AnasthesiolIntensivmedNotfallmedSchmerztherAComparisonoftheEfficacyandAdverseEffectsofDouble-LumenEndobronchialTubesandBronchi

33、alBlockersinThoracicSurgery:ASystematicReviewandMeta-analysisofRandomizedControlledTrials.2015JournalofCardiothoracicandVascularAnesthesia可用于幼儿可用于幼儿实现叶、段萎陷叶、段萎陷易置入，气道易置入，气道损伤小小进ICU不用不用换管管萎陷慢萎陷慢贵易移位易移位有被有被闭合器切割危合器切割危险BB萎陷快萎陷快费用低用低到位好到位好不可用于幼儿不可用于幼儿困困难气道易失气道易失败DLTBB-定位定位听听诊，光学探条和，光学探条和纤支支镜Placementoft

34、heUniventtubewithoutfiberopticbronchoscopeassistance.2010AA盲插、听盲插、听诊Positioningoftheuniventtubewithbronchialblockerwithoutfibreopticbronchoscopy.2007EuropeanJournalofAnaesthesiologyETCO2Usingthecapnographtoconfirmlungisolationwhenusingabronchialblocker.2010JournalofClinicalAnesthesia气道峰气道峰压差差气道峰气道峰压

35、差差值变化在支气管封堵器定位的化在支气管封堵器定位的应用用.2018临床肺科床肺科杂志志BB-加快加快萎陷萎陷50%,到到单肺通气开始。肺通气开始。Bronchialblockerlungcollapsetechnique:nitrousoxideforfacilitatinglungcollapseduringone-lungventilationwithabronchialblocker.2014 Anesthesia and nesthesia and AnalgesianalgesiaN2O:O2断开断开60s，-30cmH2O,COPD患者能明患者能明显缩短萎陷短萎陷时间。Acomp

36、arisonofthedisconnectiontechniquewithcontinuousbronchialsuctionforlungdeflationwhenusingtheArndtendobronchialblockerduringvideo-assistedthoracoscopy:Arandomisedtrial.2015EuropeanJournalofAnaesthesiology负压抽吸抽吸+断开断开结结论论Whichdeviceshouldbeconsideredthebestforlungisolation:double-lumenendotrachealtubeversusbronchialblockers.CurrOpinAnaesthesiol.2007EvidenceBaseSurroundingBronchialBlockerUseContinuestoEvolveJournalofCardiothoracicandVascularAnesthesia2018,Pagese14-e15HilaryP.Grocott,Canada个体化个体化重新重新认识BB