纤维支气管镜引导双腔支气管插管法与听诊法的临床效果比较

目的 探讨纤维支气管镜(FOB)引导下双腔支气管(DLT)插管与听诊法的临床差异.方法 选取40例实施择期开胸食道癌根治手术的全麻患者,采用计算机随机法分为FOB引导组(A组)和听诊后FOB定位组(B组),每组20例.静脉麻醉诱导,待患者意识丧失肌肉松弛后行左侧DLT(L-DLT)操作.采用普通喉镜显露声门后,A组插入L-DLT至主支气管,FOB监视下引导支气管侧导管的尖端继续插入,当导管尖端越过隆突后,即退出FOB;B组按常规的听诊法定位.两组插管完成后均用FOB检查,确定并修正不良定位.观察两组定位时间、置管深度、实际到位率以及气管插管相关并发症的差异.结果 A组插管完成时间明显长于B组(P＜0.05),定位调整时间明显短于B组(P＜0.05),操作总时间两组差异无统计学意义(P＞0.05),而一次正确到位率A组明显高于B组(P＜0.05).经纤支镜检查,插入过深为B组错位最主要原因,且发生率明显高于A组(P＜0.05).结论 纤维支气管镜引导法用于左侧双腔支气管插管,与传统听诊法比较,虽然延长插管时问.但是缩短了定位调整时间,不延长操作总时间,并且显著提高插管完成后的一次正确到位率.

A comparison of the effect of auscultation and double-lumen endobronchial tube guided by fiberoptic bronchoscope

This study aims to compare the differences between auscultation and double-lumen endobronchial tube（DLT）insertion guided by fiberoptic bronchoscope（FOB）. Forty patients who scheduled for thoracic surgery were randomly assigned to group A（20 cases）using the guidance of FOB method and group B（20 cases）using the auscultation method for tracheal intubation.After intravenous anesthesia induction,insertion of left DLT（L-DLT）was performed.After glottis was revealed using laryngoscope,L-DLT were inserted in the main bronchus in group A under the assistance of FOB which exited when the tip across the carina.The auscultation method was used in group B.Both groups were inspected by FOB after intubation to identify and correct poor positioning.The time of positioning,depth of intubation,achievement ratio and complications in the two groups were observed. In group A,the time of intubation were longer than that in group B（P 0.05）.Group A was shorter than group B（P 0.05）in the time of positioning and adjustment with the aid of FOB.There was no statistical significance in the whole operation time（P 0.05）.The one-time achievement ratio in group A was higher than that in group B（P 0.05）.According to bronchofiberscopy,over insertion was the main cause of malposition in group B,which was significantly higher than that in group A（P 0.05）. Compared with the traditional auscultation method,the guidance of FOB needs more time in intubation and shorter time in positioning,causes no delay in the whole time of operation,and can effectively improve the one-time achievement ratio of intubation.