P_(ET)CO_2和P_(peak)监测在双腔支气管导管插管中的应用

目的探讨非通气侧呼气末CO2分压(PETCO2)和通气侧气道峰压(Ppeak)联合监测用于左侧双腔支气管导管(L-DLT)插管定位的可行性。方法 60例胸腔镜择期手术患者,随机分为两组,每组30例:A组(普通听诊组):根据两肺分别行单肺通气时呼吸音的听诊情况调节插管深度定位;B组(PETCO2和Ppeak组):通过监测非通气侧呼气末CO2分压(PETCO2)和通气侧吸气峰压(Ppeak)的变化调整导管的位置。记录两组患者的插管定位时间、临床定位满意率和术后并发症发生率。结果与A组(126.53±19.14)s比较,B组患者插管定位时间(57.17±14.02)s明显缩短(p<0.01);与A组比较,B组患者术后并发症的发生率也明显降低(p<0.05);B组患者的临床定位满意率(83.3%)也显著高于A组(56.7%,p<0.05)。结论和传统听诊法相比,通过监测非通气侧PETCO2和通气侧Ppeak的变化定位时间短,定位满意率高,术后并发症的发生率降低。

APPLICATIONS OF PETCO2 AND PPEAK IN THE INTUBATION WITH A DOUBLE-LUMEN ENDOBRONCHIAL TUBE

Objective To evaluate the tip position of left - sided DLTs by the changes of Ppeak in the ventila- ted side and P_ET CO2 in the non - ventilated side during OLV. Methods 60 patients requiring double - lumen endo- bronchial tubes insertion for thoracic surgery were randomly divided into two groups, 30 cases in each group： Group A （group of auscultation） ： according to the auscultation of breath during OLV to correct position of DLTs; Group B （group of P_ETCO_2 and P_peak ） ： positioning L- DLTs according to P_ETCO_2 in non -ventilated side and P_peak in ventila- ted side. After initial positioning, all patients were observed and adjusted the malpositioned DLTs with FOB, the cases of proper intubations, the time of intubation and postoperative complications were recorded. Results Compared with Group A （126. 53 ＋ 19. 14）sec, the time of intubation in Group B（ 57. 17 ± 14.02）sec were significantly decreased （p 〈0. 05） ;cases of proper intubations in Group A（56. 7% ） were less than that of Group B（83.3%, p 〈0.05）. compared with Group A ,the incidence of postoperative complications in Group B were decreased （p 〈 0.05 ）. Conclu- sion The monitorings ofP_peak and P_ET CO_2 can effectively and safely improve the positioning of DLT, cases of proper intubations were increased, the time of intubation and the incidence of postoperative complications were decreased.