经支气管镜呼气末二氧化碳探查对难治性气胸胸膜瘘口引流支气管的定位价值

Transbronchoscopic end-tidal carbon dioxide detection for location of the leading bronchus in patients with pneumothorax

目的 探讨经支气管镜呼气未二氧化碳（EtCO_2）探查对难治性气胸胸膜瘘口引流支气管的定位价值.方法 选择我院2013年1-6月经球囊导管探查阴性的难治性气胸4例,经支气管镜送入采样导管、运用旁流EtCO_2测定法来定位气胸破裂口引流支气管.以患侧主支气管EtCO_2作为参考值,分别测定不同叶段支气管EtCO_2,然后向EtCO_2明显降低的支气管注入不同剂量的自身全血＋凝血酶,观察封堵结果、判断EtCO_2探测效果.结果以自体血封堵成功作为判断EtCO_2探测阳性的标准,与患侧主支气管EtCO_2相比较,4例患者共有7支叶、段支气管出现EtCO_2下降,幅度为2～8 mmHg（1 mmHg=0.133 kPa）,向上述支气管注入自身全血＋凝血酶均封堵成功.结论EtCO_2是一种新的引流支气管的探查方法,可以作为球囊探查失败时的补救方法.

Objective To evaluate the effect of end-tidal carbon dioxide （EtCO_2） detection for location of the leading bronchus in patients with pneumothorax.Methods Transbronchoscopic EtCO_2 detection was performed in 4 patients with intractable pneumothorax in whom transbronchoscopic balloon detection failed to localize the leading bronchus.A specific bronchus was suspected to be the leading bronchus when its EtCO_2 value was significantly lower than that of the main bronchus of the affected lung.After the pleural air leakage was successfully sealed by bronchial occlusion of the suspected bronchus,the EtCO_2 was confirmed to indicate the leading bronchus.Results Transbronchoscopic EtCO_2 detection successfully located the leading bronchus in all 4 patients.Conclusion Transbronchoscopic EtCO_2 detection is a new method of locating the leading bronchus in patients with intractable pneumothorax.