纤维支气管镜辅助双腔支气管导管插管

目的对Robertshow双腔支气管导管（DLT）插管进行研究，以进一步指导双腔支气管导管插管，方法限期普胸科肿瘤手术病人60例，采用Robertshow双腔支气管导管，插管后先用听诊法进行分隔定位，记录导管深度，随后用纤维支气管镜检查DLT的位置并作调整。病人改变体位后，再一次纤支镜检查导管位置并调整。观察不同方法下DLT插管分隔情况及体位变动对导管位置的影响。结果听诊下导管到位54例，经纤支镜检查导管到位28例、位置不当20例、严重不当6例，位置不当和严重不当的26例经纤支镜下调整导管均到位；听诊下导管未到位的6例经纤支镜下定位仍有4例位置不当和严重不当。听诊定位成功率52％（28／54），纤支镜辅助下导管定位成功率93％（56／60）；体位改变导管移位率20％（12／60）。结论Robertshaw双腔支气管导管在听诊法下插管分隔成功率低，纤支镜可以有效进行分析定位，而病人改变体位后需常规重新定位。

Study on fiberoptic bronchoscopy assisting DLT intubation

Objective To study the role of fiberoptic bronchoscopy for placing and monitoring DLTs after blind intubation and after positioning the patient.Methods Sixty patients of thoracic surgery requiring DLT insertion were prospectively studied.Bronchoscopy was performed by a different anesthesiologist after intubation and conventional clinical verification of correct paacement and after positioning for thoracotomy.Result 6 patients can not be separated the lung by conventional clinical methods time after time,so they were placed by fiberoptic.In patients in whom placement was judged correct by clinical assessment,malpositioning was detected by bronchoscopy in 26 cases,6 of which were critical.After patient's positioning,DLTs was found to be displaced in 12 cases,10 of which were critical.Proximal malpositions were frequent than distal.Conclusion After blind intubation and positioning,most DLTs require repositioning.Routine bronchosocopy is necessary after intubation and after patient's positioning with the use of double-lumen tubes.