左侧双腔支气管导管移位时其支气管气囊压力变化比较

Bronchial cuff pressure changes when left-sided double-lumen endobronchial tube was displaced

目的：比较和观察2种不同的左侧双腔支气管导管从理想位置脱出时所产生的的压力变化。方法拟择期行胸科手术患者41例，年龄29～81岁，美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级 I～Ⅲ级，随机将其分为2组：驼人双腔支气管导管组（T 组，n ＝21），Smith 双腔支气管导管组（B 组，n ＝20）。麻醉诱导后，T 组经口插入驼人医疗器械有限公司生产的普通型左侧双腔支气管导管，B 组经口插入相应型号的portex Blue line左侧双腔支气管导管。在纤维支气管镜辅助可视条件下令双腔支气管导管支气管气囊上边缘刚好位于隆突嵴下，此位置亦是此研究设计的0．0 cm 的位置。将指示气囊通过三通连接一次性压力传感器，随后通过三通向支气管气囊充入空气使支气管气囊压力达到30 cmH2 O，然后使导管以0．5 cm 单位向外回退，直至退至2．0 cm 位置并同时记录每一位置的支气管气囊压力。结果2组在2．0 cm 位置压力均低于初始压力（30 cmH2 O）（P ＜0．01）。在2组中，导管在0．0～2．0位置之间移动时，支气管气囊压力均表现出逐渐降低的趋势（P ＜0．01），且 B 组整体支气管气囊压力降低量和降低率大于 T 组（P ＜0．01）。结论2种双腔支气管导管从理想位置脱出时其支气管气囊压力均表现降低，B 组双腔管支气管导管气囊压力降低量和降低率均大于 T 组。

Objective To compare and observe the variation of pressure on two left-sided double-lumen endobronchial tubes caused by shift off from the ideal position.Methods A total of 41 cases of American Society of Anesthesiologists（ASA）Ⅰ - Ⅲ patients（gender not limited） aged between 29 and 81 years old who had been scheduled for elective thoracic surgery were randomly divided into two groups：Tuoren double-lumen endobronchial tube group（group T,n =21） and Smith double-lumen endobronchial tube group （group B,n = 20 ）.After anesthesia induction,group T was inserted orally with the common type of left-sided double-lumen endobronchial tube made by Tuoren Medical Instrument Co.,Ltd.,whereas group B was inserted orally with the corresponding type of Portex？ Blue Line？ left-sided double-lumen endobronchial tube.Under the visual assistance of fiberoptic bronchoscope,the top edge of the bronchial cuff of double-lumen endobronchial tube was just located under the ridge of the carina,where was also the “0.0 cm position”designed in the present study.The indication cuff was connected with a＆nbsp;disposable pressure sensor via three-way stopcock.The bronchial cuff was filled with air via a three-way stopcock in order to achieve a pressure up to 30 cmH 2 O.Then,the tube was retracted outward in 0.5 cm,until to the 2.0 cm position.Meanwhile,the pressure of bronchial cuff at each position was respectively recorded.Results The pressure on the 2.0 cm position was lower than that on the initial position（30 cmH2 O）in both groups（P 〈0.01）.In both groups,when the tube was moved from 0.0 cm to 2.0 cm position,a decrease tendency of the pressure in bronchial cuff was exhibited （P 〈 0.01 ）.Moreover,the amount and rate of decrease in overall pressure of bronchial cuff in group B were more than those in group T（P 〈0.01）.Conclusion When the two kinds of double-lumen endobronchial tubes were shifted from the ideal position,the pressure of bronchial cuff was accordingly reduced.But,the amount and rate of reduction in the pressure of bronchial cuff of Smith double-lumen endobronchial tube were more than those of Tuoren double-lumen endobronchial tube.