Đánh giá hiệu quả ứng dụng dùng ống nội soi mềm PUSEN trong đặt nội khí quản 2 nòng
Authors: Nguyễn Hậu 
Published: May 2023

Đặt vấn đề: Ống nội khí quản 2 nòng thường được sử dụng nhiều nhất để cách ly phổi trong phẫu thuật lồng ngực. Ống nội soi mềm khí phế quản được lựa chọn để xác định đúng vị trí sau khi đặt nội khí quản. Tính toán chi phí mua ban đầu, sử dụng, bảo trì và làm vệ sinh ống, giá thành sử dụng ống nội soi mềm thông thường lên đến 312 $ mỗi ca. Ống PUSEN là một ống soi mềm linh hoạt với đường kính nhỏ, giúp dễ dàng đi qua ống NKQ 2 nòng cỡ 32F trở lên, đồng thời với giá thành rẻ sẽ tiết kiệm chi phí hơn với chi phí chỉ 5 đến 10 $ khi sử dụng. Do đó chúng tôi tiến hành nghiên cứu đánh giá hiệu quả sử dụng dùng ống PUSEN trong đặt NKQ 2 nòng trên bệnh nhân phẫu thuật lồng ngực.

Đối tượng, phương pháp: Đây là 1 nghiên cứu mô tả tiến cứu có so sánh, được thực hiện tại bệnh viện Trung Ương Huế. Tổng cộng có 60 bệnh nhân được lựa chọn ngẫu nhiên chia thành 2 nhóm là nhóm M (n = 30) và nhóm P (n = 30). Mục tiêu chính đánh giá khả năng ứng dụng sử dụng ống nội soi mềm PUSEN trong đặt NKQ 2 nòng. Mục tiêu thứ 2 khảo sát các biến chứng có thể có xảy ra của phương pháp này.

Kết quả: Không có sự khác biệt trong việc đặt NKQ dễ hơn ở cả 2 nhóm, tuy nhiên thời gian xác định vị trí chính xác của ống NKQ 2 nòng ở nhóm P ngắn hơn so với nhóm M (61s và 150s). Bên cạnh đó, độ lệch vị trí ống của nhóm P cũng ít hơn so với nhóm M. Kết quả cũng cho thấy phổi được cách ly và sự hài lòng của PTV ở nhóm P cũng vượt trội hơn so với nhóm M.

Kết luận: Chúng tôi nhận thấy đây là 1 phương pháp cải tiến có hiệu quả tốt tương tự với ống nội soi khí phế quản trong việc đặt và kiểm tra ống nội khí quản 2 nòng sau khi đặt. Đồng thời với giá thành rẻ, dễ sử dụng có thể ứng dụng được ở nhiều bệnh viện chưa có điều kiện trang bị ống nội soi mềm tại phòng mổ.

ABSTRACT EVALUATION OF THE USE OF PUSEN FIBER OPTIC DURING DOUBLE LUMEN INTUBATION

Introduction: Double lumen endotracheal tubes (DLT) are commonly used to provide single lung ventilation during thoracic surgery. A fiber optic bronchoscope (FOB) is typically used to confirm accurate DLT placement. Accounting for initial purchase, maintenance, repair and cleaning, the use of an FOB can cost as much as $312 per procedure. The PUSEN is a flexible fiber optic with small scope size can easily go through 32F DLT or bigger. Moreover, it costs 5 to 10 dollars per case, which will lower the cost of use. In this study, we compared the effectiveness of PUSEN was used for double lumen intubation.

Methods: This is a randomized controlled comparative study performed at HUE central hospital. A total of 60 patients were enrolled and randomly assigned to either a c-DLT (n = 30) or PUSEN (n = 30). Our main objective was to evaluate the possibility of using the PUSEN tube in the intubation of a double - lumen intubation and to investigate possible complications.

Results: There was no difference in the ease of intubation, the time to correct tube placement was significantly faster using PUSEN (61 vs. 150 s). Additionally, the incidence of tube malposition was significantly reduced in the P group. Better lung isolation and happier surgeons were found in group P compared to group M.

Conclussion: We found this to be an improved method with similar efficacy to the bronchoscope in placing and examining the double - lumen endotracheal tube after placement. At the same time, with low cost and ease of use, it can be applied in many hospitals that do not have the conditions to equip a flexible endoscope in the operating room.