胸部CT指引双腔支气管导管插管的临床应用效果

Clinical effect of chest CT displaying the relative horizontal position of the bronchus guided double lumen endobronchial intubation

目的:探讨胸部CT显示支气管相对水平位置指引双腔支气管导管(DLT)插管的临床应用效果。方法:选择拟在全身麻醉单肺通气下行胸科手术的60例患者,随机分为胸部CT指引插管组(CT组,30例)和传统法插管组(CI组,30例)。CT组麻醉前阅读胸部CT了解支气管相对水平的位置关系,插管时支气管末端给予相对水平位置的一定角度进行插管;CI组插管时支气管末端给予水平位置的插管。两组插管后用纤维支气管镜(FOB)进行定位。记录插管时间、插管次数、插反情况、用FOB观察DLT插管的导管开口与支气管开口的对位满意情况以及术后声嘶、咽喉痛发生情况。结果:两组患者单肺通气时间与麻醉时间比较差异无统计学意义(P>0.05);CT组患者插管时间、插管尝试次数以及插反情况均低于CI组(P<0.05);FOB观察后CT组对导管开口与支气管开口对位满意情况明显好于CI组(96.67%vs 70.00%,P<0.05);CT组患者在术后24 h内声嘶、咽喉痛发生率明显低于CI组(10.00%、6.67%vs 33.33%、30.00%,均P<0.05)。患者平均CT气管横径为(17.26±2.11)mm,矢状径为(20.31±3.71)mm,左支气管直径为(13.08±1.88)mm。结论:CT指引下行双腔支气管插管准确高,对患者伤害少,安全可靠,同时可提高导管开口与支气管开口对位满意度,CT测量气管、支气管径线对DLT插管和定位有一定参考价值。

Objective： To investigate the effect of chest CT displaying the relative horizontal position of the bronchus guided double lumen endobronchial intubation. Methods： 60 patients under general anesthesia undergoing one lung ventilation and thoracic surgery were selected. The patients were randomly divided into two groups： chest CT guided intubation group（ CT group） with 30 cases and traditional intubation group（ CI group） with 30 cases. The chest CT was read before anesthesia in the CT group to understand position relative to the level of bronchial intubation. The bronchial intubation was carried out under a certain angle to the horizontal position in the CT group. The bronchial intubation in CI group were given under horizontal position. The fiberoptic bronchoscope were positioned after intubation in the two groups. The intubation time,intubation times and reversal insertion were observed. The satisfactory with opening para bronchus opening by FOB of DLT catheter,postoperative hoarseness and sore throat condition were observed and compared between the two groups. Results： The single lung ventilation time and anesthesia time had no significant difference between the two groups（ P〈0. 05）. The intubation time,intubation attempts and insert cases in the CT group were lower than those in the CI group（ P〈0. 05）. The satisfaction with catheter opening and bronchus opening para in CT group by DLT of FOB was higher than that in the CI group[（ 96. 67%） vs（ 70%）（ P〈0. 05） ]. The hoarseness and sore throat rates within 24 h after surgery in the CT group were significantly lower than those in the CI group [（ 10. 00%）,（ 6. 67%） vs（ 33. 33%）,（ 30. 00%） ]（ P〈0. 05）. Conclusion： Double lumen endotracheal intubation in the chest under the guidance of CT is accurate with less damage and high safety and reliablity,which can improve patient satisfaction on the catheter opening para bronchus. The CT measurement of tracheal and bronchial diameter can better reflect the real situation of trachea and bronchus,which has a certain reference value for the intubation and positioning of DLT catheter.