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[摘要]目的探?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。[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[]R614.2[文献标识码]A[]1673-7210（2017）09（a）-0077-04[Abstract]ObjectiveToexploretheapplicationofCT3Dreconstructionmeasurementintheplacementofbronchialocclusivedeviceinnewborn′sairpassage.Methods28casesofnewbornsunderwentlimitedone-lungventilationsurgeryinGuangzhouWomenandChildrenMedicalCenterfromJanuary2015toSeptember2016wereselectedasthesubjects.TheywererandomlyandevenlydividedintothetraditionalgroupandCTgroupaccordingtotheplacementmodeofbronchialocclusivedevice.Bronchialocclusivedeviceofthetraditionalgroupwasplacedintheblind-matewaynamelywithmanualcontrolledbreathingresistancecombinedwithauscultationlocalization，whilebronchialocclusivedeviceoftheCTgroupwasplacedguidedbytheCT3Dreconstructionmeasurementdata.TwogroupsofchildrenwerecomparedforSpO2，EtCO2，PaO2andPaCO2atthetimeofdouble-lungventilation（T1），immediateone-lungventilation（T2），10minafterone-lungventilation（T3）and10minafterpulmonarycollapse（T4）.Localizationtimeofplacement，pulmonarycollapsetime，pulmonarycollapsequality，intraoperativecatheterandtheshiftofbronchialocclusivedevicebeforetheoperationwereobservedandcounted.Airpassagemucosaldamagewasevaluatedbyfibreopticbronchoscopeafteroperation.ResultsTherewerenostatisticaldifferencesbetweentwogroupsofchildreninSpO2，EtCO2，PaO2andPaCO2atT1（P>0.05）paredwiththetraditionalgroup，SpO2andPaO2increasedatT2andT3，whileEtCO2andPaCO2decreasedinCTgroup（P<0.05）paredwiththetraditionalgroup，localizationtimeandpulmonarycollapsetimeweredecreased，pulmonarycollapsequalitywasimproved，andairpassagemucosaldamagewasdecreasedinCTgroup（P<0.05）.Therewasnostatisticaldifferencebetweenthetwogroupsinthenumberofintraoperativecatheterandshiftofbronchialocclusivedevice（P>0.05）.ConclusionPreoperativespiralCTairwayreconstructionandanalysisforthenewbornswhoneedone-lungventilationduringtheoperationcanmorecomprehensivelyandaccuratelyevaluatethechildren′strachealcondition，soastoaccurately，safelyandefficientlyplacebronchialocclusivedevice.[Keywords]Bronchialocclusivedevice；Newborn；CT3Dreconstruction；One-lungventilation；Fibreopticbronchoscope单肺通气技术可提供清晰的术野...