左双腔支气管导管插管深度的研究.doc

左双腔支气管导管插管深度的研究
王庆亮张东赵砚丽张煜东刘晓明
（河北省人民医院麻醉科，石家庄，050051）
通讯作者：赵砚丽主任医师教授硕士生导师
【摘要】：目的探讨合适的插管深度降低患者侧卧位后错位发生率及减轻错位程度。方法选择成年胸科麻醉手术患者60例,静脉诱导后插入RobertshawDLT。在FOB引导下将导管插入左主支气管,调整双腔管的位置将其随机分为三组:Ⅰ组:患者仰卧,头中立位,从气管腔侧插入FOB,隆突在正前方清晰可见,调整导管使蓝色支气管套囊上缘正好在隆突下可见(充气后);然后从左支气管腔插入FOB,可清晰看到左上叶支气管开口。Ⅱ组:基本上同Ⅰ组,不同之处在于:将蓝色支气管套囊上缘调整在隆突下看不见;从DLT的左支气管腔插入FOB,透过DLT支气管管壁向右看并调整导管位置,使隆突正好位于蓝色支气管套囊上缘与左支气管腔壁上不透光黑线的正中央;=3\*ROMANIII组:从气管腔侧插入FOB,左支气管腔壁上不透光黑线正好在隆突下可见,然后从左支气管腔插入FOB,可清晰看到左上叶支气管开口。结果据60例观测,,DLT位置重新调整率Ⅱ,=3\*ROMANIII组明显低于Ⅰ组﹙p＜0.05﹚,Ⅱ,=3\*ROMANIII组无差异（p≥0.05）.结论Ⅱ,=3\*ROMANIII组插管深度明显降低患者侧卧位后错位发生率及减轻错位程度，插管深度位于Ⅱ,=3\*ROMANIII组为合适的插管深度。
【关键词】左双腔支气管最适深度纤维支气管镜
depthoftheleftRobertshawdouble-lumentube
WANGQing-liangZHANGDongZHAOYan-liZHANGYu-dongLIUXiao-ming(TheHebeiGeneralHospital,HebeiShijiazhuang,050051，China)
【Abstract】ObjectiveToexplorethatsuitabledepthcanreduceincidenceofmalpositioningfromthesupinetothelateraldecubitusposition.MethodsUndergenralanesthesia,60adultpetientsundergoingthoracicsurgerywereintubatedwithRobertshawDLTs.Toadjustpositioningofleftdouble-lumentube,andrandomlyassignthreegroups:Ⅰgroup:InthesupinePosition,viatherighttracheallumen,theendoscopistshouldseeaclear,straight-aheadviewofthetrachealcarina,Itisimportanttoseetheuppersurfaceoftheleftendobronchialbluecuffjustbelowthecarina,thenlookingdowntheleftendobronchiallumen,theorificeoftheLULbronchusshould
beseenclearly.Ⅱgroup:Theproximalshoulderedgeofthebluebronchialcuffshouldnotbevisualizedatthecarina.However,throughtheleftbronchiallumen,andbytransparencyacrossthewallofthetube,thepositionofthetubeisadjustedsothatthecarinaismidwaybetweentheblackradiopaquelineandthetopofthebronchialcuff.Finally,theorificeoftheLULbronchusandthebronchialcarinashouldbeclearlyseen.
Ⅲgroup:viatherighttracheallumen,theblackradiopaquelineshouldbevisualizedatthecarina,theorificeoftheLULbronchusshouldbeseenclearly.Results:TheincidenceofrepositioningissignificantlylessintheⅡ,ⅢgroupscomparedtotheⅠgroup﹙p＜0.05﹚,Ⅱ,Ⅲarenotdifferent﹙p≥0.05﹚.ConclusionDe