纤维支气管镜辅助右双腔气管导管插管

目的对右Robertshaw双腔气管导管插管进行研究，进一步指导右侧双腔气管导管插管。方法40例病人，拟行左侧入路胸科手术。所有病人均采用右侧35F Robertshaw双腔气管导管(DLT)。插管后先用听诊法进行分隔定位，记录导管深度。随后用支气管纤维镜检查DLT位置作出分析并调整导管。调整好导管位置后，记录插管深度。病人摆好体位后，再一次纤支镜检查导管位置并调整。观察不同方法下右DLTs插管分隔的情况及体位变动对导管位置的影响。结果听诊下有8例经反复调整导管无法到位，在纤支镜下直接定位。在听诊定位后经纤支镜检查，发现导管位置不当5例，导管位置严重不当的24例，以远端错位为主21例。在纤支镜直接定位下仍有8例病人导管位置严重不当。改变体住后再检查，有14例发生了导管移位。其中8例出现严重位置不当。以近端移位为主12例。结论右Robertshaw双腔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。而改变体住常使导管位置改变，在体位改变后应常规重新定位。

Role of fiberoptic bronchoscopy in conjunction with the use of right double-lumen tubes for thoracic anesthesia

Objective: To study the role of fiberoptic bronchoscopy for placing and monitoring right sided DLTs after blind intubation and after positioning the patient. Methods: Forty patients having thoracic surgery requiring right DLT insertion were prospectively studied. Bronchoscopy was performed by a different anesthesiologist after intubation and conventional clinical verification of correct placement and after positioning for thoracotomy. Results: 8 patients can not separate the lung by conventional clinical methods time after time, so was placed by fiberoptic. in patients in whom placement was judged correct by clinical assessment, malpositioning was detected by bronchoscopy in 29 cases, 24 of which were critical. After patient positioning, DLTs was found to be displaced in 14 cases, 8 of which were critical. Proximal malpositions were frequent than distal. Conclusion: After blind intubation and positioning, most of DLTs required repositioning. Routine bronchoscopy is necessary after intubation and after patient positioning with the use of right double-lumen tubes.