老年患者双腔支气管导管插管深度与体表甲状软骨水平至剑突距离的关系

目的：探讨老年患者双腔支气管导管（ double-lumen endobronchial tube ， DLT）插管深度（ Y）与甲状软骨水平至剑突距离（ X）之间的关系。方法选择老年胸科手术115例，分为男性右DLT 33例（ MR组），女性右DLT 32例（ FR组），男性左DLT 29例（ML组）和女性左DLT 21例（FL组）。患者进入手术室后即测量患者甲状软骨水平至剑突距离（X），麻醉诱导采用经静脉血浆靶控泵注丙泊酚2．8～3．8μg/ml和瑞芬太尼4．5～5．5 ng/ml，患者入睡后再静注肌松剂顺式阿曲库铵0．15 mg/kg。插入DLT后纤维支气管镜（fiberoptic bronchoscope，FB）直视下调整并确定DLT管端位置对位准确，观察标定DLT尖端至门齿的距离，即插管深度（Y）。对4组X和Y进行相关和回归分析。结果每组DLT 插入的适宜深度（Y）与该组患者的年龄无相关（r＝0．096，P＝0．309），但与患者的体重、身高、性别（女）有显著性相关（r＝0．231，P＝0．013；r＝0.512，P＝0．000；r＝0．790，P＝0．000）。 MR组回归方程：Y∧＝0．9806X＋2．8132（ n＝33，r＝0．9364，P＝0．000）；FR组回归方程：Y∧＝0．9409X＋3．2516（n＝32，r ＝0．8573，P ＝0.000）；ML 组回归方程：Y∧＝1．0182X ＋1．8134（n ＝29，r ＝0．9662，P ＝0.000）；FL组回归方程：Y∧＝0．9227X＋3．6046（n＝21，r＝0．9180，P＝0．000）。结论测量体表甲状软骨水平至剑突距离可指导老年患者DLT的插管深度，且和FB的定位高度一致。

Relationship Between Double-lumen Endobronchial Intubation Depth and Distance from the Level of Thyroid Cartilage to the Xiphoid in Senile Patients

Objective To explore the relationship between the intubation depth （ Y ） of double-lumen endobronchial tube （ DLT） and the distance from the level of the thyroid cartilage to the xiphoid （ X） in senile patients . Methods We selected 115 elderly patients undergoing minimally invasive thoracic surgery , who were divided into male right DLT group （MR, 33 cases）, female right DLT group （FR, 32 cases）, male left DLT group （ML, 29 cases）, and female left DLT group （FL, 21 cases）, respectively. The distance from the level of the thyroid cartilage to the xiphoid （ X） were measured in the operating room .Anesthesia was induced with propofol 2.8-3.8 μg/ml and remifentanil 4.5-5.5 ng/ml by TCI.Muscle relaxant cis-atracurium was given 0.15 mg/kg by intravenous after falling asleep .Double-lumen endotracheal tube was inserted under direct vision of fiberoptic bronchoscopy （ FB） to adjust and determine bronchial tube position accurately .The distance from the bronchial catheter tip to the incisors , namely intubation depth （Y）, was recorded.Then we conducted the correlation and regression analysis of two indicators （X and Y） in the above four groups. Results Though the age had no significant relationship with Y in each group （r=0.096,P=0.309）, the body weight, height, and gender were significantly correlated with Y （r=0.231,P=0.013;r=0.512, P=0.000,r=0.790,P=0.000）.The regression equations were Y∧=0.9806X＋2.8132 （n=33, r=0.9364, P=0.000） in the MR group, Y∧=0.9409X＋3.2516 （ n=32, r=0.8573, P=0.000） in the FR group, Y∧=1.0182X＋1.8134 （n=29, r=0.9662, P=0.000） in the ML group, and Y∧=0.9227X＋3.6046 （n=21, r=0.9180, P=0.000） in the FL group, respectively. Conclusion The distance from the level of thyroid cartilage to the xiphoid can be expected to instruct the intubation depth of the double -lumen endobronchial intubation in elderly patients, and is highly consistent with the position of FB .