肺阻抗图用于判断患者气管插管位置准确性的临床研究  

A clinical study of impedance graph in verifying tracheal intubation

作　　者：姚永兴[1] 姜桢[1] 陆霞晖 贺吉辉 马晓旭[3] 祝继洪[3] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032 [2]杭州钢铁集团总医院麻醉科 [3]浙江大学医学院附属邵逸夫医院麻醉科

出　　处：《中华医学杂志》2007年第13期898-901,共4页National Medical Journal of China

摘　　要：目的研究肺阻抗图用于判断气管插管位置正确性的应用价值。方法需插管全身麻醉患者36例,在气管插管成功后插入相同口径的气管导管至食管,一人将螺纹管接于气管或食管后挤压呼吸皮囊,另两人(有经验者和无经验者)分别用肺阻抗图法、呼末二氧化碳图(P_(et)CO_2)法和听诊法判断接上的是气管还是食管,记录正确性和作出判断所需要的时间。结果共进行了216次判断。正确率:阻抗法和 P_(et)CO_2法均正确判断了气管和食管插管,两者正确率差异无统计学意义;听诊法有经验者(n=72次)气管误判为食管2次,食管误判为气管1次;听诊法无经验者(n=72次)气管误判为食管5次,食管误判为气管9次,总正确率(81%)与有经验者(96%)比较,差异有统计学意义(P<0.01),与阻抗法和 P_(et)CO_2法比较,差异有统计学意义(P<0.01);阻抗法和 P_(et)CO_2法总的敏感度和特异性均为1,听诊法总的敏感度为0.90,特异性为0.86。作出判断所需时间:在3种方法中,无论判断气管还是食管,阻抗法与听诊法所需的时间差异无统计学意义;P_(et)CO_2法作出判断所需的时间最长(3.4 s±1.3s 和3.7s±1.4 s),与阻抗法(1.6 s±0.3 s 和2.1 8±1.1 s)和听诊法(1.7 s±0.7 s 和2.5 s±1.7 s)比较,差异有统计学意义(P<0.01)。用阻抗法或听诊法判断气管所需的时间(1.6 s±0.3 s)比用同样的方法判断食管所需的时间(2.1 s±1.1 s)短,差异有统计学意义(P<0.01)。结论阻抗法判断气管插管位置的正确率与 P_(et)CO_2法一致,而所需时间比 P_(et)CO_2法短,是判断气管插管位置正确性的有效方法之一。Objective To evaluate the clinical usefulness of impedance pneumography in determining the tube placement during endotracheal intubation. Methods Thirty-six endotracheallyintubated patients for elective operations underwent general anesthesia and endotracheal intubation, and then a second identical tube was inserted into the esophagus under laryngoscopic control. The ventilation circuit was then attached either to tracheal or esophageal tube. The tube position was determined by 2 blinded examiners, one experienced and the other inexperienced, using three methods： impedance pneumography, eapnography, and auscultation. The order of the tubes tested and the order of the methods used were randomized. The observation results and the time needed to determine were recorded by another assistant. Results Of the 216 tests conducted, both examiners correcdy diagnosed the position of the tube using impedance pneumography and capnography. In the auscultation method there were two false-negative results （with the tracheal tube identified as esophageal） and one false-positive （with the esophageal tube identified as tracheal） by the experienced examiner, while five false-negative results （wlth the tracheal tube identified as esophageal） and nine false-positive （with the esophageal tube identified as tracheal） by the inexperienced examiner. With the sensitivity and specificity of impedance pneumography as standards （ 100% ） , the sensitivity and specificity of the capnography were both 100% too, and the sensitivity and specificity of the auscultation method were 90% and 86% respectively, both significandy lower than those of the other 2 methods （all P〈0.01）. Capnography needed 3.4 s±1.3 s and 3.7 s±1.4 s to verify tracheal intubation and esophageal intubation respectively, both significantly longer than those of the auscultation methods （ 1.7s ± 0.7 s and 2.5 s ± 1.7 s） and impedance pneumography （ 1.6 ± 0.3 and 2.1 ± 1.1 s, all P 〈 0.01 ）. It took less time for impedance pneumography a

关 键 词：插管法 气管内 听诊 二氧化碳描记术 

分 类 号：R614[医药卫生—麻醉学]