术中双腔支气管插管位置监测方法的评估

Evaluation of the monitorings in positioning double-lumen endobronchial tubes during one-lung ventilation

目的比较五种监测方法在术中核查双腔支气管插管位置变化的价值。方法选择需行单肺通气的手术患者60例,放置手术体位后同时监测气道阻力、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)、流量-容量环和支气管气囊压力,3min后使用纤维支气管镜对双腔支气管插管位置进行判断及调整。结果气道阻力监测的灵敏度为63·64%,特异度为89·80%;PETCO2监测的灵敏度为54·55%,特异度为87·76%;流量-容量环监测的灵敏度为81·82%,特异度为85·71%。结论气道阻力监测、PETCO2监测、流量-容量环监测有助于临床判断双腔支气管插管位置。

Objective To evaluate five monitoring items in positioning the double-lumen tube(DLT) during one-lung ventilation. Methods Sixty selected patients undergoing one-lung ventilation were studied.Airway pressure, SpO_2, P_ETCO_2,flow-volume loops and bronchial cuff pressure were monitored continuously for three minutes after positioning the patients.Then fiberoptic bronchoscopy was used to check the position of DLT and correct it. Results The sensitivity for airway pressure monitoring was 63.64%, and specificity 89.80%, for P_ETCO_2 54.55% ,and 87.76%, for flow-volume loops 81.82%,and 85.71%. Conclusion During OLV,the monitorings of airway pressure, P_ETCO_2 and flow-volume loops are all helpful to find the displacement of DLT timely and effectively.