双腔支气管导管管端位置对肺隔离和通气效果的影响

Influence of the position of double-lumen endobronchial tube on the efficacy of lung separation and ventilation

目的观测胸科麻醉用双腔支气管导管(DLT)行肺隔离时变动体位和手术操作引起DLT管端错位而影响肺隔离和通气效果的发生率和影响程度,并探讨有效处理措施。方法选择成年胸科麻醉手术患者688例,静脉诱导后插入MallinckrodtDLT。平卧位用纤维支气管镜(FOB)检查导管管端正确到位,并确认单肺通气获得完善的肺隔离和通气效果。侧卧位后行非术侧单侧肺通气15min时,以及术中发生肺隔离效果不佳或脉搏血氧饱和度<90%时用FOB检查DLT管端位置并予以必要的调整。结果侧卧位后112例患者发生管端错位(16.3%),其中12.8%患者发生低氧血症,3.3%患者出现隔离漏气现象。侧卧位后左DLT管端错位发生率(19.7%)比右DLT(12.2%)高(P<0.01)。侧卧位时曾发生过管端错位的112例中,术中有16例(14.3%)再次发生管端错位,比侧卧位时未发生管端错位而术中出现管端错位的发生率(1.2%)明显高(P<0.01)。结论胸科麻醉用MallinckrodtDLT行肺隔离时,侧卧位过程可以引起16.3%已正确到位的DLT管端发生错位;在FOB直视下调整管端位置后,术中仍有14.3%的几率再次发生管端错位。

Objective To observe the incidence of double-lumen endobronchial tubes （DLT） malposifion caused by body position change or surgical manipulation and its impact on the efficacy of lung separation and ventilation. Methods Totally 688 patients undergoing thoracic surgery were enrolled in this study. The patients were intubated with Mallinckrodt DLT following intravenous anesthesia induction. The DLT position was corrected with fiberoptic bronchoscope （FOB）, and successful lung separation and satisfactory ventilation were ensured during one-lung ventilation in the supine position. Bronchoscopy was performed immediately and the DLT position was corrected 15 minutes after dependent lung ventilation in the lateral position or in case of ineffective lung separation or SpOz declination to below 90%. Results DLT malposition occurred after lateralization in 112 （16.3%） patients, of whom 12.8% developed hypoxemia and 3.3% encountered air leak. The incidence of left-sided DLT malposition after lateralization was higher than that of right-sided DLT malposition （19.7% vs 12.2%, P〈0.01）. DLT malposition occurring in 112 patients after lateralization reoccurred in 16 （14.3%） patients during surgery, and the malposition incidence was significantly higher than that of malposition occurring only during surgery （1.2%, P〈0.01）. Conclusion Malposition of Mallinckrodt double-lumen tubes for lung separation during thoracic anesthesia occurs in 16.3% patients when shifting to lateral position, may reoccur in 14.3% of the patients despite previous FOB positioning.