纤维支气管镜在双腔支气管导管定位中的应用

THE ROLE OF FIBEROPTIC BRONCHOSCOPE IN THE POSITIONING OF DOUBLE-LUMEN ENDOBRONCHIAL TUBE

目的:用纤维支气管镜行双腔支气管导管定位,总结双腔管在国人中应用的规律,以指导临床。方法:120例择期行开胸手术,术中需要单肺通气的胸部肿瘤患者,ASA分级I￣II级。麻醉诱导后由一位麻醉医师选择并插入一次性PVC-Robertshaw双腔支气管导管,先用听诊法确定导管的位置,再由另一位麻醉医师用纤维支气管镜(fiberopticbronchoscope,FOB)确定和调整导管的位置,记录结果。当病人由平卧位改为侧卧位时,再进行听诊和FOB检查,记录结果。当导管位置偏离正确位置0.5cm以上时认为是导管错位。同时记录单肺通气时的气道峰压(Paw)、血氧饱和度(SPO2)。结果:在平卧位和侧卧位时,FOB检查时有71.3%和45.0%的导管位置需要重新定位。平卧位导管错位时,插入过深和插入过浅发生率相似,侧卧位以插入过浅为主。右侧双腔管较左侧双腔管更易出现错位。结论:使用Robertshaw导管行肺隔离时,在病人平卧位和侧卧位时用纤维支气管镜对导管定位更为准确、可靠。

Objective：To study the role of FOB in placing and monitoring right-sided and left-sided PVC- Robertshaw double-lumen endobronchial tube（DLT） in Chinese patients after blind intubation and its relation with patient positioning.Methods： One hundred and twenty ASA Ⅰ-Ⅱ patients who underwent thoracic operation and required one lung ventilation （OLV）were studied. After anesthesia induction, a selected Portex Robertshaw DLT was inserted by one anesthetist. Bronchoscopy was performed by another anesthetist after intubation and auscuhative verification of correct placement and after patient positioning for thoracotomy. A DLT was considered malplacement when its deviation 〉0.5cm. Then the results were recorded. Meanwhile Paw and SPO2 during OLV were recorded. Results： After blind intubation and patient positioning, DLT was found to be displaced in 71.3% and 45.0% by Bronchoscopy. Distal malposition was similar with proximal malposition after intubation. But after positioning, proximal malposition occurred more frequently than distal malposition. Right-sided DLT was significantly more likely to be displaced than left-sided DLT.Conclusion：The use of FOB as a diagnostic tool in positioning the Robertshaw PVC-DLT both after blind intubation and after patient positioning is reliable and necessary.