左侧开胸术时主导管位置听诊法用于Univent导管的定位

Placement of the Univent tube by auscultating the position of the main tube alone for the patients undergoing left thoracic surgery

目的评价主导管位置听诊法用于Univent导管定位的效果。方法60例ASAⅠ或Ⅱ级的患者,随机均分为三组,纤维支气管镜(FOB)组、主导管位置听诊(FS)组、推荐法插管(RIT)组。记录插管时间、堵塞导管试插的次数(FOB组除外)、主导管到隆突的距离、堵塞气囊充气量和位置分级、术中单肺通气时间,术毕检查气管黏膜损伤情况并评分。结果FS组堵塞导管均一次插入左侧,RIT组25%一次插入左侧。FS组插管时间比FOB组和RIT组短(P<0.05)。RIT组堵塞气囊充气量比FS组多,堵塞气囊位置评分比FOB组高(P<0.05)。黏膜损伤三组差异无统计学意义。结论FS法Univent导管定位较快速、准确,RIT法定位准确性较差,易出现过深、过浅的问题。

Objective To evaluate the efficacy and the time needed for intubation when the Univent tube placement was performed by auscultating the position of the main tube alone, Methods Sixty ASA class Ⅰ or Ⅱ adult patients requiring one-lung ventilation for elective left thoracic surgery under general anesthesia were randomly allocated to three groups by computer： the fiberoptic bronchoscope group （FOB, n= 20）, the positioning main tube by auscultation group （FS, n= 20）, and the recommended intubation technique group （RIT, n = 20）, After induction Of general anesthesia, the Univent tube was inserted and positioned by the same anesthetist and was＇ checked by another anesthetist with FOB, The numbers of attempts to advance the main tube or the blocker tube into the left bronchus, the distance from the top of the main tube to the carina, the grade of the bronchial blocker position, the air volume for blocker cuff, the intubation time, the time for one-lung ventilation, and the degree of left main bronchial injury were recorded, Results In FS group, 100% blocker placement was successful on the first attempt, which was a 25% （5/20） in RIT group, The blocker insertion attempts, air volume of blocker cuff in RIT group were more than those in FS group （P〈0. 05）, The grades of blocker position in RIT group were more than those in FOB group, No significant difference was seen in the bronchial injury among the three groups. Conclusion Positioning the main tube by auscultation is feasible with a less time consumption and relative technical convenience for inserting the Univent tube.