支气管封堵器的临床应用-课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,二级,三级,四级,五级,18/8/4,#,支气管封堵器的临床应用,支气管封堵器的临床应用,1,支气管封堵器,-,中国知网,76,；,2003-2018,支气管封堵器 -中国知网76；2003-2018,2,精品资料,精品资料,3,你怎么称呼老师？,如果老师最后没有总结一节课的重点的难点，你是否会认为老师的教学方法需要改进？,你所经历的课堂，是讲座式还是讨论式？,教师的教鞭,“不怕太阳晒，也不怕那风雨狂，只怕先生骂我笨，没有学问无颜见爹娘 ”,“太阳当空照，花儿对我笑，小鸟说早早早”,支气管封堵器的临床应用-课件,4,支气管封堵器,-,中国知网,支气管封堵器 -中国知网,5,支气管封堵器的临床应用-课件,6,支气管封堵器的临床应用-课件,7,Bronchial Blocker (BB)PubMed,Clinical Trial,28,1996,2018,1,/,y,Bronchial Blocker (BB)PubMed,8,Bronchial Blocker (BB)PubMed,Case Report,103,人,-102,；动物,-1,。,1983, 2018,Bronchial Blocker (BB)PubMed,9,Case Report,Case Report,10,BB,BB,始于,1936,，,Magill,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。（带套囊尿管）,现,BB,不断有新品面世。,BBBB 始于1936，Magill 在胸科手术中使用末端带,11,BB,类型,Arndt,BB,Cohen,BB,TCB Univent BB,Fuji,BB,E Z BB,Coopdech,BB,BB 类型Arndt BBCohen BBTCB Unive,12,BB,：困难气道,DLT,的板凳队员,One,lung ventilation in cases with,unsuccessful double-lumen endobronchial,intubation,.,1993 Chinese journal of anesthesiology,Independent,placement of a bronchial blocker for single-lung ventilation: an alternative method for,the difficult airway,.,1996 Anesthesia & Analgesia,Use of the Univent System tube for,difficult int,ubation and for achieving one-lung anaesthesia,.,1996 Acta Anaesthesiologica Scandinavica,Lung isolation techniques for patients with,difficult airway,.,2010 Current opinion in anaesthesiology,One-lung ventilation in a patient with stenting for,tracheobronchial stenosis,caused by,esophageal cancer,.,2011 Journal of Clinical Anesthesia,Use of the Coopdech Bronchial Blocker as a tracheal tube introducer in a patient with,difficult laryngoscopy,.,2010,Journal of Clinical Anesthesia,BB：困难气道DLT 的板凳队员One lung venti,13,BB-,小儿,Anaesthetic management for a left pneumonectomy,in a child with bronchopleural fistula,.,2000,Pediatric Anesthesia,One-lung anesthesia was successfully maintained by means of,Fogarty Catheter in,infant.,2002 Masui,Lung isolation,in a child,with unilateral necrotizing Clostridium perfringens pneumonia.,2005 critical care medicine,Case,report of using a connector (phycon TCB bronchial blocker) for,pediatric one-lung,anesthesia,.,2007,Masui,Single lung ventilation in,a young child,for repair of,coarctation,of aorta,.,2,010 Journal of the College of Physicians and Surgeons-Pakistan,Alternative,methods of lung isolation in cases of,pediatric,bilateral thoracoscopic surgery,.,2016,Pediatric Anesthesia,BB-小儿Anaesthetic management fo,14,BB-,常规应用,（单肺通气）,Bronchial Blocker,Versus,Left,Double-Lumen,Endotracheal Tube,for,One-Lung,Ventilation,in,Right Video-Assisted,Thoracoscopic,Surgery.,2018,Journal of Cardiothoracic and Vascular Anesthesia,Lung Isolation,for Thoracic Surgery: From Inception to Evidence-Based.,2017,Review,Journal of Cardiothoracic and Vascular Anesthesia,A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery:,A Systematic Review,and Meta-analysis of Randomized Controlled Trials.,2015,Journal of Cardiothoracic and Vascular Anesthesia,An update onbronchialblockers during lung separation techniques in adults.,2003,Anesthesia & Analgesia,BB-常规应用（单肺通气）Bronchial Blocker,15,BB-,肺叶，肺段隔离,Segmental Lung Isolation,in a Postpneumonectomy Patient Undergoing Contralateral Lung Resection.,2017,Journal of Cardiothoracic and Vascular Anesthesia,Lung isolation in patients with previous lung resections: Selective sequential,lobar blockade,using a Fuji Uniblocker endobronchial blocker.,2016,Revista Espaola de Anestesiologa y Reanimacin,Update on selective,lobar blockade,during pulmonary resections.,2009,Current Opinion in Anesthesiology,Sequential,lobar-lung-lobar isolation,using a deflecting tip bronchial blocker.,2006,J,ournal of clinical anesthesia,BB-肺叶，肺段隔离Segmental Lung Isola,16,A Prospective Comparison of,Intraluminal and Extraluminal,Placement of the 9-French Arndt Bronchial Blocker in Adult Thoracic Surgery Patients.,2017,Journal of Cardiothoracic and Vascular Anesthesia,成人胸外科患者,9-F Arndt,支气管阻,封堵器,腔内和腔外,置入,的前瞻性比较,。,腔外,方法,放置的时间显著,缩短,，,术后喉咙痛,的发生率没有任何差异,。,无论,是在腔内还是在腔外,，,大部分,支气管内阻滞,器,至少需要一次术,中重新定位。,A Prospective Comparison of In,17,BB-,用于气管出血止血,Use of bronchial blocker in emergent thoracotomy in presence of,upper airway hemorrhage, and,cervical spine fracture,: a difficult decision.,2018,Revista Brasileira de Anestesiologia,Experience of hemostasis in,tracheal bleeding,very close to the carina by the bronchial blocker: a case report.,2016,Korean Journal of Anesthesiology,Successful management of a,trauma,patient with pulmonary hemorrhage using a wire-guided bronchial blocker,.,2007,The Journal of Trauma: Injury, Infection, and Critical Care.,BB-,用于阻断单侧肺漏气,Management of,traumatic,pneumothorax with,massive air leakage,: role of a bronchial blocker: a case report.,2014,Korean Journal of Anesthesiology,BB,治疗肺血栓取栓术后大咯血,Management of,Massive Hemoptysis,After Pulmonary Thromboembolectomy Using a Double Bronchial Blocker System.,2017,Journal of Cardiothoracic and Vascular Anesthesia,BB-用于气管出血止血BB-用于阻断单侧肺漏气BB 治疗肺血,18,BB-,支气管残端瘘,Two successful cases in the treatment of,post-operative bronchial stump fistulae,.,2005,Annals of Thoracic and Cardiovascular Surgery,BB-,气管切开后置入单肺通气,Extraluminal Placement of an Arndt Bronchial Blocker Through a,Tracheal Stoma,.,2016,Journal of Cardiothoracic and Vascular Anesthesia,Exsanguinating tuberculosis-related hemoptysis: bronchial blocker introduced through,percutaneous tracheostomy,.,2009,Minerva Anestesiologica,Foley catheter used as bronchial blocker for one lung ventilation in a patient with,tracheostomy,-a case report.,1995,Acta anaesthesiologica Sinica,BB-,病态肥胖患者,Lung,separationin themorbidlyobesepatient.,2012,Anesthesiol Res Pract,BB-,气道巨大肿物,Successful one-lung ventilation using a bronchial blocker tube for,a large tracheal carcinoma resection,. 2017,J Clin Anesth.,BB- 支气管残端瘘BB-病态肥胖患者BB-气道巨大肿物,19,DLT + BB,DLT,复合,BB,肺感染肺叶切除,Combination of a double-lumen tracheal tube and bronchial blocker for a patient with continuous,bleeding,due to invasive,lung infection,.,2015 Journal of Clinical Anesthesia,DLT,复合,BB,长期吸烟，气道分泌物多的肺叶切除,Anesthetic Management of Simultaneous Right Lobectomy and Esophagectomy with a Double-lumen Tracheal Tube and,BronchialBlocker,.,2016,Masui,DLT,复合,BB,弥补,DLT,隔离不全,Failure of lung isolation,by a double-lumen endotracheal tube rescued by the concomitant use of an arndt bronchial blocker under direct visualization,.,2013,A&A Case Reports Journal,DLT + BBDLT 复合 BB 肺感染肺叶切除Com,20,DLT + BB,DLT,复合,BB,-,支气管胸膜瘘,Lobarbronchialblockade in bronchopleural fistula.,1992 Anesthesiology,DLT,复合,BB,肺毛霉菌病的单肺通气,Successful Use of a Double Lumen Endotracheal Tube and Bronchial Blocker for Lung Isolation in Pulmonary Mucormycosis.,2018,Journal of Cardiothoracic and Vascular Anesthesia,DLT,复合,BB,心外手术气道出血,Bronchial blocker versus double-lumen tube for lung isolation with,massive hemoptysis,during,cardiac surgery,.,2013,Journal of Cardiothoracic and Vascular Anesthesia,DLT + BBDLT 复合 BB -支气管胸膜瘘Lo,21,LM （laryngeal mask）+ BB,LM+BB - DLT,失败,Differential lung ventilation using laryngeal mask airway and a bronchial blocker tube for a patient with,unanticipated difficult intubation,.,2007 Masui.,LM + BB ,气道肿物,Use of the proseal laryngeal mask airway and arndt bronchial blocker for lung separation in a patient with a,tracheal mass and aspiration risk,.,2010,Journal of Cardiothoracic and Vascular Anesthesia,LM+BB -,气管切开,Lung isolation using a laryngeal mask airway and a bronchial blocker in a patient with a recent,tracheostomy,.,2008,Journal of Cardiothoracic and Vascular Anesthesia,LM （laryngeal mask）+ BBLM+BB -,22,不良事件,BB,尖端被切断,Transection of a,Coopdech bronchial blocker,tip during bronchial resection for,right upper lobectomy,: a case report.,2015,Korean Journal of Anesthesiology,Resection of the,Arndt Bronchial Blocker,during stapler resection of the,left lower lobe,.,2006,Journal of Cardiothoracic and Vascular Anesthesia,BB,尖端扭转,The tip fracture of the,Coopdech bronchial blocker,during insertion in the patient with lung surgery.,2014,Korean Journal of Anesthesiology,BB,尖端折断,Accidental fracture of the tip of the,Coopdech bronchial blocker,during insertion for one lung ventilation.,2010,Korean Journal of Anesthesiology,BB,套囊破裂,Differential lung ventilation using,Fogarty catheter,after accidental damage of bronchial blocker cuff,.,1999,Masui,A Ballooning Crisis: Three Cases of Bronchial Blocker Malfunction and A Review.,2017,Journal of Cardiothoracic and Vascular Anesthesia,Avulsion of a bronchial blocker cuff,in the trachea when using a Parker Flex-Tip endotracheal tube,。,2010,J Cardiothorac Vasc Anesth.,不良事件BB 尖端被切断BB 尖端扭转BB 尖端折断BB 套,23,BB -,肺污染,Case report:,pulmonary soiling,after one-lung ventilation with a bronchial blocker.,2002,Canadian Journal of Anesthesia,BB,低氧血症,Severe hypoxemia after,suction of the nonventilated lung,via the bronchial blocker lumen of the,univent tube,.,1996,Journal of Cardiothoracic and Vascular Anesthesia,BB,-,严重低氧血症,Bronchial,blocker,for,one-lung,ventilation,：,A,unanticipated,complication,2,011,Indian,J,Anaesth,气管支气管,-,应用,BB,失败,Congenital tracheal bronchus: the inability to isolate the right lung with a univent bronchial blocker tube,.,2000 A,nesthesia and,A,nalgesia,Right upper lobe tracheal bronchus: anesthetic challenge in one-lung ventilated patients -A report of three cases-.,2013,Korean Journal of Anesthesiology,不良事件,BB -肺污染BB 低氧血症BB - 严重低氧血症 气管支,24,其他应用,BB-,取牙,Extraction of foreign body with,Arndt bronchial blocker.,2015,Revista Espaola de Anestesiologa y Reanimacin,BB-,高频通气,High frequency jet ventilation,of one lung using a bronchial blocker of Univent during,carinal resection.,2010,J,ournal of korean medical science,High-frequency jet ventilation using the Arndtbronchialblockerfor refractory hypoxemia during one-lung ventilation in a,myasthenic patient with asthma,.,2014,J,ournal of clinical anesthesia,BB CPAP,联合改善低氧,Continuous positive airway pressure,applied through a bronchial blocker as a treatment for hypoxemia due to stenosis of the left main bronchus.,2009,Anesthesiology,其他应用BB-取牙Extraction of foreign,25,其他应用,Gorham-Stout,综合征：,The Gorham-Stout syndrome: one lung ventilation with a bronchial blocker. A case of Gorhams disease with chylothorax.,2009,Pediatric Anesthesia,支气管扩张性骨软骨病,Management of one lung ventilation with bronchial blocker catheter for a patient with tracheobronchopathia osteochondroplastica,. 2007,Masui,微创,CABG,The use of a bronchial blocker compared with a double-lumen tube for single-lung ventilation during minimally invasive direct coronary artery bypass surgery.,2002,J Cardiothorac Vasc Anesth.,其他应用Gorham-Stout综合征：The Gorham,26,E-Z,BB,Lung isolation using EZ-Blocker bronchial block in a patient during a,bilateral,endoscopic thoracic sympathectomy,.,2014,Revista Espaola de Anestesiologa y Reanimacin,Sequential lung isolation using a bronchial blocker (EZ-Blocker) for,bilateral,dorsal sympathectomy.,2013,Journal of Clinical Anesthesia,Sequential,bilateral,lung isolation with a single bronchial blocker.,2013,A&A Case Reports Journal,E-Z BBLung isolation using EZ-,27,Use of Bronchial Blockers for Lung,Isolation.,2018 Anasthesiol Intensivmed Notfallmed Schmerzther,A,Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.,2015 Journal of Cardiothoracic and Vascular Anesthesia,BB,优点,可用于幼儿,实现叶、段萎陷,易置入，气道损伤小,进,ICU,不用换管,缺点,萎陷慢,贵,易移位,有被闭合器切割危险,DLT,优点,萎陷快,费用低,到位好,缺点,不可用于幼儿,困难气道易失败,Use of Bronchial Blockers for,28,BB-,定位,听诊，光学探条和纤支镜,Placement of the Univent tube without fiberoptic bronchoscope assistance. 2010,A A,盲插、听诊,Positioning of the univent tube with bronchial blocker without fibreoptic bronchoscopy,.,2007,European Journal of Anaesthesiology,ETCO,2,Using the capnograph to confirm lung isolation when using a bronchial blocker.,2010,Journal of Clinical Anesthesia,气道峰压差,气道峰压差值变化在支气管封堵器定位的应用,. 2018,临床肺科杂志,BB- 定位听诊，光学探条和纤支镜Placement of,29,BB-,加快,萎陷,N,2,O,:,O,2,50%,到单肺通气开始。,Bronchial blocker lung collapse technique: nitrous oxide for facilitating lung collapse during one-lung ventilation with a bronchial blocker.,2014 A,nesthesia and,A,nalgesia,负压抽吸,+,断开,断开,60s,，,-30cmH,2,O,COPD,患者能明显缩短萎陷时间。,A comparison of the disconnection technique with continuous bronchial suction for lung deflation when using the Arndt endobronchial blocker during video-assisted thoracoscopy: A randomised trial.,2015,European Journal of Anaesthesiology,BB- 加快萎陷N2O : O2 50%,到单肺通气开始。B,30,结 论,个体化,Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers.,Curr Opin Anaesthesiol.,2007,重新认识,BB,Evidence Base Surrounding Bronchial Blocker Use Continues to Evolve,Journal of Cardiothoracic and Vascular Anesthesia,2018, Pages e14-e15,Hilary P.Grocott,Canada,结 论个体化Which device should be,31,谢 谢,明年再聚,谢 谢 明年再聚,32,