双腔支气管导管插管深度对患者侧卧位后导管错位发生率的影响

The effect of left double-lumen tube depth on the incidence of malpositioning from the supine to the lateral decubitus position

目的 比较左双腔支气管导管不同的插管深度对患者侧卧位后导管错位发生率的影响.方法 选择全麻胸科手术患者60例,在纤维支气管镜（fibroptic bronchoscopy,FOB）引导下将Robertshaw双腔支气管导管（double-lumen tube,DLT）插入左主支气管,采用随机数字表法调整双腔管的位置将其分为3组：Ⅰ组：患者仰卧,从气管腔侧插入FOB,隆突在正前方清晰可见,调整导管使蓝色支气管套囊上缘正好在隆突下可见（充气后）;从左支气管腔插入FOB,可清晰看到左肺上叶支气管开口.Ⅱ组：从气管腔侧插入FOB,将蓝色支气管套囊上缘调整在隆突下恰不可见,即从DLT的左支气管腔插入FOB,使隆突正好位于蓝色支气管套囊上缘与左支气管腔壁上不透光黑线的正中央,可清晰看到左上叶支气管开口;Ⅲ组：从气管腔侧插入FOB,左支气管腔壁上不透光黑线正好在隆突下可见,从左支气管腔插入FOB,可清晰看到左肺上叶支气管开口.结果 仰卧位到侧卧位后,DLT头侧移位Ⅰ、Ⅱ、Ⅲ组各11例、4例、2例,Ⅱ、Ⅲ组明显低于Ⅰ组（P＜0.05）,Ⅱ、Ⅲ组间比较差异无统计学意义;DLT尾侧移位的发生组间比较差异无统计学意义;DLT重新调整Ⅰ、Ⅱ、Ⅲ组各11例、5例、4例,Ⅱ、Ⅲ组明显低于Ⅰ组（P＜0.05）,Ⅱ、Ⅲ组差异无统计学意义（P＞0.05）.结论 隆突正好位于蓝色支气管套囊上缘与左支气管腔壁上不透光黑线的正中央或左支气管腔壁上不透光黑线正好在隆突下可见明显降低患者侧卧位后错位发生率.

Objective To explore whether different depth of dual chamber bronchial catheter can influence the incidence of malpositioning from the supine to the lateral decubitus position. Methods According to the relations of the tracheal carina and the cuff of left DLT, 60 patients undergoing thoracic surgery were randomly divided into three groups： group Ⅰ , the tracheal carina should be seen clearly via the right tracheal lumen in the supine position, it is important to see the upper surface of the left endobronchial blue cuff just below the carina, then looking down the left endobronchial lumen, the orifice of the LUL bronchus should be seen clearly; group Ⅱ： the proximal shoulder edge of the blue bronchial cuff should not be visualized at the carina.However, through the left endobronchial lumen, the position of the left endobronchial lumen is midway between the black radiopaque line and the upper edge of the bronchial cuff, meanwhile, the orifice of the LUL bronchus and the bronchial carina should be seen clearly; group Ⅲ： via the right tracheal lumen,the black radiopaque line should be visualized at the carina, the orifice of the LUL bronchus should be seen through the left endobronchial lumen clearly. Results From the supine to the lateral decubitus position,to proximal positioning, Patients who were found catheter proximal malpositioning after decubitus changing in group Ⅰ , group Ⅱ and group Ⅲ were 11, 4 and 2 respectively. The incidence of malpositioning in group Ⅱ and group Ⅲ was significantly lower than that of group Ⅰ （P＜0.05）. Patients who were found catheter distal malpositioning after decubitus changing in group Ⅰ , group Ⅱ and group Ⅲ were 11,5 and 4 respectively. The incidence of malpositioning in group Ⅱ and group Ⅲ was significantly lower than that of group Ⅰ （P＜0.05）. No significant changes were found between group Ⅱ and group Ⅲ. Conclusion Suitable depth of left DLT can reduce malpositioning incidence from the supine to the lateral decubitus position. The depth is more suitable if tracheal carina is in the midway between black radiopaque line and upper edge of bronchial cuff.