纤维支气管镜在双腔支气管导管定位中的应用

目的:用纤维支气管镜行双腔支气管导管定位,总结双腔管在国人中应用的规律,以指导临床.方法:120例择期行开胸手术,术中需要单肺通气的胸部肿瘤患者,ASA分级Ⅰ～Ⅱ级.麻醉诱导后由一位麻醉医师选择并插入一次性PVCRobertshaw双腔支气管导管,先用听诊法确定导管的位置,再由另一位麻醉医师用纤维支气管镜(fiberoptic bronchoscope,FOB)确定和调整导管的位置,记录结果.当病人由平卧位改为侧卧位时,再进行听诊和FOB检查,记录结果.当导管位置偏离正确位置0.5cm以上时认为是导管错位.同时记录单肺通气时的气道峰压(Paw)、血氧饱和度(SPO2).结果:在平卧位和侧卧位时,FOB检查时有71.3%和45.0%的导管位置需要重新定位.平卧位导管错位时,插入过深和插入过浅发生率相似,侧卧位以插入过浅为主.右侧双腔管较左侧双腔管更易出现错位.结论:使用Robertshaw导管行肺隔离时,在病人平卧位和侧卧位时用纤维支气管镜对导管定位更为准确、可靠.

THE ROLE OF FIBEROPTIC BRONCHOSCOPE IN THE POSITIONING OF DOUBLE-LUMEN ENDOBRONCHIAL TUBE

Objective:To study the role of FOB in placing and monitoring right-sided and left-sided PVC-Robertshaw double-lumen endobronchial tube(DLT) in Chinese patients after blind intubation and its relation with patient positioning.Methods: One hundred and twenty ASA I~II patients who underwent thoracic operation and required one lung ventilation(OLV )were studied. After anesthesia induction, a selected Portex Robertshaw DLT was inserted by one anesthetist. Bronchoscopy was performed by another anesthetist after intubation and auscultative verification of correct placement and after patient positioning for thoracotomy. A DLT was considered malplacement when its deviation >0.5cm. Then the results were recorded. Meanwhile Paw and SPO2 during OLV were recorded. Results: After blind intubation and patient positioning, DLT was found to be displaced in 71.3% and 45.0% by Bronchoscopy. Distal malposition was similar with proximal malposition after intubation. But after positioning, proximal malposition occurred more frequently than distal malposition. Right-sided DLT was significantly more likely to be displaced than left-sided DLT.Conclusion:The use of FOB as a diagnostic tool in positioning the Robertshaw PVC-DLT both after blind intubation and after patient positioning is reliable and necessary.