一种改良右侧双腔支气管导管定位法在胸腔镜手术中的应用*

目的拟应用一种改良右侧双腔支气管导管(RDLT)定位法,解除右上肺叶阻塞。方法纳入美国麻醉医师协会分级(ASA)Ⅱ或Ⅲ级择期需行RDLT插管的胸腔镜手术患者70例(男48例,女22例),年龄18~78岁,随机分为常规组(支气管套囊充气后在隆突下可见,C组)和改良组(支气管套囊充气后1/3~1/2在隆突上,M组),每组35例。观察指标:(1)插管深度和右上肺叶阻塞例数;(2)右主支气管(RMB)的长度;(3)侧卧位RDLT头侧移位例数、隆突上支气管套囊遮挡左主支气管(LMB)例数;(4)进入胸腔即刻和单肺通气(OLV)30 min时的左肺萎陷效果。结果 (1)M组插管深度明显小于C组(P0.05),M组右上肺叶阻塞例数明显低于C组(0 vs 11,P0.01),C组11例右上肺阻塞者RDLT调整至改良位后阻塞全部解除;(2)两组RMB长度无明显差异(P0.05),但C组出现右上肺叶阻塞患者的RMB长度明显短于未出现右上肺叶阻塞者(P0.01);(3)两组侧卧位后RDLT移位例数无明显差异(P0.05)。M组支气管套囊部分遮挡LMB例数比C组高(P0.01);(4)M组进入胸腔即刻左肺萎陷效果比C组差(P0.05),但经调整OLV 30 min后两组左肺萎陷效果无明显差异(P0.05)。结论改良RDLT定位法可减少右上肺叶阻塞的发生,更适用于RMB短的患者,可作为常规定位法右上肺叶阻塞时的解除方法,也可直接以该法定位RDLT,但需警惕RDLT从RMB脱出。

Application of modified positioning method of right-sided double-lumen endobronchial tube in thoracoscopic surgery*

Abstract: Objective?To discuss a modified positioning method of right-sided double-lumen endobronchial tube (RDLT) for removing right upper lobe (RUL) obstruction.?Methods?70 ASA II or III patients with RDLT intubation scheduled for thoracoscopic surgery (48 men and 22 women) was enrolled, aged 18?~?78 years. All the patients were randomly assigned into two groups: conventional group (inflated bronchial cuff just below the carina, group C) and modified group (1/3?~?1/2 inflated bronchial cuff above the carina, group M), 35 patients in each group. Primary outcomes measures: The RDLT insertion depth and the number of cases of RUL obstruction. The right mainstem bronchus (RMB) length. The number of cases of RDLT malposition and bronchial cuff herniation after lateral decubitus position. The effect of left lung collapse at the moment of chest opened and 30 min later.?Results?The RDLT insertion depth of group M was significantly shorter than that of group C (P??0.05). In group C, the RMB length of patients with RUL obstruction was shorter than that of patients without RUL obstruction (P??0.05). The number of cases of bronchial cuff herniation in group M were more than that in group C (P??0.05).?Conclusion?The modified RDLT positioning method can reduce the occurrence of RUL obstruction, especially for patients with short RMB, which can be used to relieve RUL obstruction caused by conventional positioning method. The RDLT can also be located directly by this method, but the RDLT prolapse from RMB must be vigilant.