超声成像技术用于双腔支气管导管插管定位的临床研究

Clinical efficacy of ultrasonic imaging to confirm double-lumen bronchial tube placement

目的探讨超声成像技术用于双腔支气管导管(DLT)插管定位的可行性。方法择期开胸手术拟行左DLT插管单肺通气(OLV)的患者60例,年龄42～64岁,Mallampati分级Ⅰ或Ⅱ级,随机双盲分为两组,每组30例。麻醉诱导静脉注射咪达唑仑0.05mg/kg、芬太尼3μg/kg、顺式阿曲库铵0.15～0.2mg/kg和丙泊酚1.5～2.0mg/kg后插入DLT,分别采用听诊法(A组)和超声成像(U组)确定导管位置,并由FOB检查并调整导管位置。结果两组DLT插管成功率为100%。两组定位DLT所需时间差异无统计学意义。经FOB检查,A组有14例(46.7%)错位,U组仅有4例(13.3%)错位(P<0.01)。结论用超声法确定和调整DLT的位置不仅较听诊法更准确、可靠,而且无创、可重复操作。

Objective To evaluate the feasibility of ultrasonic imaging to confirm double-lumen tube（DLT） placement. Methods Sixty ASA I or ]1 adults aged 42-64 years old, undergoing t thoracic surgery requiring one-lung ventilation were randomly divided into 2 groups （n： 30 each）. After anesthesia was induced with fentanyl 3 /~g/kg, propofol 1.5-2.0 mg/kg and cisatracurium besilate 0. 15-0. 2 mg/kg, DLT was inserted. Proper position of DLT was determined by auscultation （group A） or ultrasonographic measurement （group U）. Correct tracheal tube placement was furtherly confirmed using fibreoptic.bronchoscopy（FOB）. Results The successful insertion rate was 100% in both groups. There was no significant difference in the positioning time between the two groups. The FOB revealed that the incidence of malpositioning of the DLT was 13.3% in group U and 46.7% in group A, respectively. Conclusion Ultrasonic imaging is a reliable, noninvasive and accurate technique for correct positioning of DLT and should be used routinely,