气腹压力对气管隆凸位置影响的观察  

Effects of pneumoperitoneum on tracheal carina position under a variety of peritoneum pressure

作　　者：王祥和[1] 丰浩荣[1] 

机构地区：[1]解放军第98医院,浙江湖州313000

出　　处：《东南国防医药》2005年第2期101-103,共3页Military Medical Journal of Southeast China

摘　　要：目的　观察不同气腹压力对气管隆凸位置的影响。方法　选择无明显器质性疾病腹腔镜胆囊手术5 5例,分别在平卧位及头高左斜卧位时无气腹、10 mm Hg、15 mm Hg气腹6种情况下,用OL YMPUS- L F- GP测量气管导管远端至隆凸的距离,观察隆凸形态、位置的改变及气管导管支气管内插管发生率。结果　无气腹平卧位气管导管末端至隆凸距离为(4.5 9±1.6 6 ) cm,头高左斜卧位为(4.5 1±1.5 6 ) cm ;10 mm Hg平卧位气腹导管离隆凸为(3.5 1±1.6 2 ) cm,头高左斜卧位距离为(3.4 4±1.5 8) cm ;15 mm Hg气腹平卧位距离为(3.4 5±1.6 4 ) cm,头高左斜卧位距离为(3.4 2±1.5 9) cm。无气腹时两种体位隆凸至气管导管的距离无统计学意义上差别,P>0 .0 5 ;10 mm Hg及15 mm Hg气腹与无气腹时相比有统计学意义上差异(P<0 .0 1) ;头高左斜卧位10 mm Hg与15 mm Hg气腹间数值无统计学上差别。有3例气腹后气管导管进入支气管内。结论　气腹对气管至隆凸间的距离有影响,应适当减少气管导管插入气管的深度,以防支气管内插管。Objective To evaluate the effects of pneumoperitoneum on tracheal carina position.Methods Fifth-five patients undergoing laparoscopic cholecystectomy were studied. The distances from carina to the tip of the endotracheal tube were measured under the supine and Trendelenburg's position with zero,10,15mmHg pneumoperitoneum pressure.Results The distances were (4.59±1.66)cm(supine position), (4.51±1.56)cm (Trendelenburg's position) without pneumoperitoneum and (3.51±1.62)cm (supine position),(3.44±1.58)cm (Trendelenburg's position) under 10mmHg pneumoperitoneum and (3.45±1.64)cm (supine position), (3.42±1.59)cm (Trendelenburg's position) under 15mmHg pneumoperitoneum. There were no significant difference in the distances without pneumoperitoneum (P>0.05). The distances were significantly shorter under 10mmHg and 15mmHg pneumoperitoneum compared with normal peritoneum pressure(P<0.01). Endobronchial intubation were observed after pneumoperitoneum in three patients.Conclusions Pneumoperitoneum may produce cephalad movement of the carnia toward the relatively fixed endotrachealtube. We should properly decrease the length of tracheal intubation.

关 键 词：气管隆凸 气腹压力 支气管内插管 OLYMPUS P〉0.05 气管导管插入 器质性疾病 斜卧位 无气腹 平卧位 胆囊手术 方法选择 统计学 距离 头高 腹腔镜 发生率 统汁学 差别 

分 类 号：R734.1[医药卫生—肿瘤] R657.4[医药卫生—临床医学]