听诊法与呼气末CO2监测在开胸术中双腔管定位的临床应用

The clinical application of stethoscopy and PETCO2 monitoring in positioning doublelumen tube in thoracotomy

目的对比评价用听诊法及呼吸末CO2分压（PETCO2）监测在双腔管检查定位中的临床应用。方法选择择期胸外科手术病人80例，随机分为A组和B组。全麻诱导后插入DLT，A组判断双腔管位置，采用听诊法，B组采用PETCO2以进行判断。两组定位后用纤维支气管镜（FOB）检查定位和调整导管位置。侧卧后再次分别定位并采用FOB检查定位和调整导管位置。判断平、侧卧位DLT对位情7兄，记录结果。术中所有病人常规予以用PETCO2以进行监测变化。结果两组病人男女组成比例、左或是右侧支气管内插管等基本情况比较无统计学意义。仰卧位和侧卧位A组定位错位率为47．5％，30．0％，均明显高于B组的20％，7．5％，x2=6．76，5．25，P〈0．05，差异有显著性；右支气管组导管位移率与左支气管组比较（34．2％vs7．1％），x2=7．52，P〈0．01，差异有显著性。错位深度两组比较，有侧支气管组（1．3±0．4）cm明显低于左侧（2．4±1．1）cm，P〈0．01，差异有显著性。结论B组即采用PETC02以进行判断双腔管位置比A组（采用听诊法）判断来得精确。导管位移率右侧支气管组发生率高于左侧。

Objective To assess the clinical use of stethoscopy and PETCO2 monitoring in positioning double-lumen tube （ DLT ） in thoracotomy. Methods Eighty patients undergoing elective chest surgery were randomly devided into groupA and group B. After general anesthetic intubation, we judged the positon of DLT in group A by stethoscopy and that in group B by PETCO2 monitoring. All the positions of DLTs were double-checked and adjusted by bronchofibroscopy. On lateral position, we repeated the same procedure. The judged placement of DLT on dorsal and lateral position was recorded. All the patients were monitored the changes in PETCO2 during the surgery. Results The male to femal ratio and right- or left- sided DLT placement did not differ significantly. On two positions, the malposition frequency was obviously higher in group A than in group B （ x2 = 6.76 and 5.25, P〈 0.05 ）; the frequency of displacement of DLT from the fight bronchus was higher than that from the left bronchus （ X 2 = 7.52, P〈0.01 ）. and the depth of displacement from the right bronchus was smaller than the left bronchus （ P〈 0.01 ）. Conclusions PETCO2 monitoring is more accurate than stethoscopy in positioning double-lumen tube. The rate of DLT displacemnt from the right bronchus is higher than that from the left bronchus.