纤维支气管镜用于双腔支气管导管的定位

Positioning of double-lumen endobronchial tube with fiberoptic bronchoscope

目的 研究纤维支气管镜（FOB）在国人双腔支气管导管插管定位中的应用。方法 90例行择期开胸手术、术中需要单肺通气的病人,ASAI～Ⅱ级。全麻诱导后用传统方法插入双腔支气管导管。听诊法确定和调整导管的位置,然后用FOB确定和调整导管的位置。在病人由平卧位变为侧卧位后再次用FOB确定和调整导管的位置。记录各次导管的深度。结果 FOB检查发现盲法置入的68％左侧和62％右侧双腔导管位置不正确,导管过深的情况更多见;导管在最佳位置时的深度与病人的身高无相关性;24％病人侧卧位后导管位置有变动,以向近侧移动居多。结论 在初始插管及体位变动后,用纤维支气管镜确定和调整双腔导管的位置更准确、可靠,应常规使用。

Objective To study the use of fiberoptic bronchoscope in the positioning of double-lumen endobronchial tube in Chinese patients. Methods Ninety ASA Ⅰ - Ⅱ patients (60 male and 30 female) undergoing thoracic surgery requiring one-lung ventilation were enrolled in the study. Age ranged from 14-79 years (mean age 56 ±16) and the average height was 169± 6 cm (male) and 158±6 cm (female) respectively. Anesthesia was induced with fentanyl, propofol and vecuronium. Double-lumen endobronchial tube (Broncho-Cath, Mallincrodt Medical) was inserted following conventional procedure. Proper position of double-lumen tube(DLT) was determined by auscultation. Fiberoptic bronchoscope was made if needed. The fiberoptic bronchoscopy was repeated after lateral decubitus positioning of the patient. The depth of the tube inserted was recorded. Results The fiberoptic bronchoscopy revealed that the incidence of malpositioning of the left-sided DLT was 68% and of right-sided DLT was 62% . The most common malposition was that the tube was placed too deep. The dislodgement of DLT in lateral decubitus positioning of the patient occurred in 24% patients and in most cases the DLT was moved upward. The depth of insertion did not correlate with the patient' s height. Conclusion Fiberoptic bronchoscopy is a reliable technique for correct positioning of DLT and should be used routinely.