超声辅助应用于双腔支气管导管插管定位的临床观察

Clinical Observation of the Application of Ultrasonic Assist in the Localization of Double-Lumen Tube

目的探讨超声扫描法用于双腔支气管导管(Double-lumen Tube,DLT)插管定位在胸外科手术的可行性。方法将我院2015年1月—2016年6月期间拟行双腔支气管导管插管的胸外科手术患者80例,随机分为超声定位组(U组)和传统听诊定位组(C组),每组各40例。U组患者在超声扫描下行双腔支气管导管插管并确定导管位置,C组患者则使用传统听诊法确定导管位置。最后两组均采用纤维支气管镜(FOB)判断导管的位置。记录两组患者双腔支气管导管准确定位的病例数以及定位所需插管时间。结果通过纤维支气管镜验证,U组和C组定位正确例数分别为35例和26例,对位正确率分别为87.5%和65.0%,差异具有统计学意义(P<0.05);定位时间分别为(155.10±23.4)s和(151.60±22.8)s,差异无统计学意义(P>0.05);U组和C组确定DLT位置的准确率分别为92.5%和67.5%,两组准确率比较差异具有统计学意义(P<0.05)。结论超声扫描法引导双腔支气管导管插管定位在判断DLT位置的准确率较传统听诊法高,提高了DLT定位的成功率。应用超声扫描法进行双腔支气管导管插管定位,是除纤维支气管镜定位法外另一种行之有效的方法。

Objective To evaluate the feasibility of ultrasound scanning confirm double - lumen tube （DLT） place- ment in thoracic surgery. Methods 80 patients who accepted thoracic surgical procedures with the left bronchial intubation and general anesthesia were randomly divided into 2 groups ： the ultrasonic imaging group （ Group U） （40 cases） and the conventional auscultation group （Group C） （40 cases）. Patients in Group U were subjected bronchial intubation by precise positioning using ultrasound scanning. Patients in Group C were subjected bronchial intubation using conventional ausculta- tion. Finally, the catheter was positioned via fiber bronchoscopy. The duration of precise positioning and time of intubation in the two groups were recorded. Results The correct position cases was 35 and 26 for Group U and Group C, the correct rates were 87.5% and 65.0% and the difference was statistically significant （P 〈0. 05）, and the time of intubation was （ 155. 10 ± 23.4） s and （ 151.60 ± 22. 8 ） s for Group U and Group C, and the difference was no statistically significant （ P 〉 0. 05 ）. The accuracy was 92.5% and 67.5% for the Group U and Group C, and the difference was statistically significant （P 〈 0. 05）. Conclusion Ultrasound scanning has the higher accuracy of position evaluation than conventional auscultation, so that improve the success rate in DLT positioning, which maybe another choice for DLT without fiberbronchoscopy.