纤维支气管镜应用于支气管插管77例

The Role of Fiberoptic Bronchoscopy for Placing Double-lumen Tub in 77 Patients

目的研究纤维支气管镜技术在支气管双腔管插管定位中的作用。方法77例行择期手术需支气管双腔管插管患者(男45例、女32例、年龄20～77岁、ASA1～3级),静脉诱导行支气管插管,传统听诊定位调整双腔管位置,再使用纤维支气管镜定位调整。结果以传统听诊方法进行左主支气管插管定位的准确率为52.17%,其余定位不准占33.33%,使用纤维支气管镜可以使插管成功率提高;另有14.49%因反复误插入另一侧支气管,需纤支镜引导下正确插入。8例右主支气管插管病例中4例传统插管方法成功,有1例术前插管成功在术中体位变动后导管位置改变时,以及其余4例因传统插管方法失败病例需纤维支气管镜直视下调整位置,调整成功。结论使用传统方法进行支气管插管和插管后调整体位时,约有半数的病人需要再次调整导管位置。因此,行支气管插管和调整体位时宜常规使用纤维支气管镜。

Objective This trial assessed the role of fiberoptie bronchoscopy for placing double - lumen tube（DLT） after blind intubation. Methods 77 patients（ male = 45, female = 32） having thoracic surgery requiring DLT insertion were prospectively studied. ＂Blind＂ tracheal intubations were done. Fiberoptie bronchoseopy was performed after intabation and conventional clinical verification of correct placement. Result After ＂blind＂ DLT intubation, in 52.17% of the left - sided DLTs was placed correctly confirmed by fiberoptic bronchoseopy assessment. In 33.33% of the patients, realpositioning was detected and corrected with fiberoptic bronehoseopy. Another 14.49% of the left - sided DLTs need to be induced with fiberoptic branchoseopy to left bronchus. 5 of the 8 Right - sided DLTs were malpositioned and corrected with fibereptic bronehoseopy .Conclusion After blind intubation and patient positioning, more than one third of DLTs required repositioning. Routine bronchoseopy is therefore recommended after intubation and after patient positioning.