Clinical Study Of Coopdech Bronchial Blocker On Lung Protection Mechanism In Patients With Pulmonary Dysfunction

Objectives:To evaluate the effect of Coopdech bronchial blocker versus double lumen tube in OLV and the influence of systemic inflammatory in patients with pulmonary dysfunction.To confirm the feasibility and safety of Coopdech bronchial blocker in patients with pulmonary dysfunction and to determine the mechanism of lung protection.Methods:According to the standard,80 patients with moderate pulmonary function scheduled for thoracotomy were randomly assigned into two groups,Coopdech bronchial blocker group(Group C)and Double lumen tube group(Group D)with 40 patients each.One-lung ventilation was achieved with either a combination of Coopdech bronchial blocker and endotracheal tube(Group C)or a double-lumen tube(Group D).The data below was recorded:(1):to evaluate the intubation manipulation of the two OLV techniques:the intubation time,the achievement ratio of the first trying of intubation,the number of times of displacement of the OLV devices perioperative,the change-ratio of hemodynamics before and after intubation immediately.(2):To evaluate the intubation manipulation of the two OLV techniques for the level of lung collapse and the exposure condition of the operation field and the airway pressure during OLV.(3):To evaluate the intubation manipulation of the two OLV techniques for the influence of the blood gas analysis during the operation:during the lateral position,arterial blood gas analyse were performed at the time 15min after DLV(T1),30min(T2)and 60min(T3)after OLV,15min after regaining DLV(T4).(4):To evaluate the effect of two OLV techniques on perioperative systemic inflammatory response:during the lateral position,the concentrations of the inflammatory factors vWF,sICAM-1,IL-8,IL-10 in the patients’venous blood sample and BALF were determined at the time 15min afterDLV(T1)and 15min 15min after regaining DLV(T4),by ELISA method.(5):To evaluate the effect of two OLV techniques on perioperative recovery:the incidence and severity of postoperative hoarseness and sore throat,the incidence of pulmonary complications.The data mentioned above was compared between the two groups.Results:The fisrt try achievement ratio of intubation was higher,and thechange ratio of MAP and HR were lower in group C than in group D(P<0.05),statistically;The intubation time was longer,the number of time of tube displacement was lower in group C than in group D(P<0.05),final operation field exposure and the collapse of the non-ventilation lung were comparable between the two groups(P>0.05).The peak airway pressure and the plat airway pressure was to advance significantly during OLV than DLV in the two groups,and the pressure value was higher statistically in group D than in group C during OLV(P<0.05).PaO2 and PaO2/FiO2 of all the patients decreased gradually.But PaO2 and PaO2/FiO2 of the patients in group C was higher statistically than that in group D at the time 30min after OLV(T2)and the time 60min after OLV(T3)(P<0.05).PaCO2 was comparable between the two groups(P>0.05).The concentrations of the inflammatory factors vWF,sICAM-1,IL-8,IL-10 in the patients’ venous blood sample and BALF increased statistically at T4 in the two groups(P<0-05).There were significant differences in the variation trend in the two groups(P<0.05).The concentrations of the inflammatory factors vWF,sICAM-1,IL-8,IL-10 in the patients’ venous blood sample and BALF was lower significantly at T4 in group C than groupD(P<0.05).The incidence and severity of hoarseness and sore throat were lower significantly in group C(P<0.05).The complication of the two groups patients was disappear more than 3 days after the operation.The incidence of pulmonary complications were comparable between the two groups(P>0.05).Conclusions:Coopdech bronchial blocker used in one-lung ventilation can improve the condition of one-lung ventilation,reduce the airway pressure and improve oxygenation condition.So it can decrease the intrapulmonary shunt fraction during one-lung ventilation in patients with pulmonary dysfunction.Coopdech bronchial blocker can be safely used in patients with pulmonary dysfunction.