侧卧位时左双腔支气管导管管端位置与吸气峰压及肺顺应性的关系  

The relationship between position of left-sided double-lumen endobronchial tubes and changes of inspiratory peak airway pressure and lung compliance in the left lateral decubitus position

作　　者：张灿洲[1] 叶靖[1] 欧阳葆怡[1] 

机构地区：[1]广州医学院第一附属医院麻醉科,广州市510120

出　　处：《河北医药》2008年第5期603-605,共3页Hebei Medical Journal

基　　金：广州市医药卫生科技一般引导项目(编号:2006-YB-153)

摘　　要：目的探讨左侧卧位时双腔支气管导管(DLT)管端位置与吸气峰压及肺顺应性变化的关系,评估DLT管端位置的量化标准。方法102例用左DLT行胸科麻醉的中青年患者,纤维支气管镜(FOB)确认插入的DLT管端位置正确,平卧位双肺通气15min后(第1阶段),左侧卧位左单侧肺通气15min(第2阶段);然后以FOB观察DLT管端位置,若发现过深移位,FOB直视下调整DLT导管至正确位置后再单侧肺通气15min(第3阶段)。观测过程监测呼吸和循环各项指标。结果左侧卧位后DLT管端过深移位发生率为19.6%。第2阶段管端错位患者的SpO2均值比第1阶段稍低;Ppeak的升幅是管端正位患者的1.6倍;MV、Cdyn、PETCO2和PaO2降幅分别是管端正位患者的2.3倍、1.5倍、3.7倍和1.5倍;用FOB观测DLT管端均已接近左下肺叶支气管开口,插管深度平均增加1.6cm,维持支气管套囊压20cmH2O的注气量比第1阶段减少42.9%。管端错位患者第3阶段的Ppeak升高(47.0%)及MV下降(3.1%)、Cdyn下降(37.2%)、PETCO2下降(2.4%)、PaO2下降(40.4%)均已接近管端正位患者第2阶段的升降幅度。结论吸气峰压和肺顺应性的变化比SpO2更敏感,提示左DLT管端发生移位。左侧卧位单肺通气气道峰压超过平卧位双肺通气时的1.6倍,绝对值超过24cmH2O,肺顺应性减少50%,应高度怀疑左DLT管端发生过深移位。Objective To observe the relationship between the tip position of left-sided double lumen eedobronchial tubes（L-DLTs） and changes of inspiratory peak airway pressure（ Ppeak ） together with dynamic lung compliance（ Cdyn）, and determine whether the tip position of L-DLTs can be evaluated by the changes of Ppeak and Cdyn in the left lateral decubitns position. Methods 102 adult patients underwent thoracic surgery were intubated with Mallinckrodt L-DLTs, the positions of which were corrected by the fiberoptic bronchoscope（FOB） in the supine position. After two lung ventilation for 15 min, the patients were turned to the left lateral decubitns position and converted to left lung ventilation for 15 min. Then tube position was checked by FOB again, if it＇ s inserted too deep into the left lower bronchi （malposition）, the L-DLT was withdrawn and guided into position by FOB, and continued to left lung ventilation for 15 min. Recoreded Ppeak, Cdyn, respiratory and hemodynamic variables. Results The incidence of malpositions was19.6% （20 cases） after placement of the patient in the lateral position. Depth of intubation in patients of malpositions during left lung ventilation in the lateral position was 1.6 cm deeper to initially place of the tube, whose Ppeak was 1.58 times higher than those of correct positions, minute ventilation （MV）, Cdyn, PETCO2 and PaO2 were 2.3 times, 1.5 times, 3.7 times and 1.5 times lower than those of correct positions, respectively. Meanwhile, the bronchial cuff volume decreased by 42.9%, SpO2 decreased to ＇about 97%. After the tips of DLTs were withdrawn to correct position, Ppeak increased only by 47.0%, MV, Cdyn, PETCO2 and PaO2 decreased only 3.1%, 37.2%, 2.4% and dO.4%, respectively, similar to those of other 82 cases. Conclusion Compare to the decrease of SpO2, it is more sensitive to indicate that the DLTs were itlserted into the left lower bronchi by the increase of Ppeak and the decrease of Cdyn under the condition in this study. If Ppeak increases more t

关 键 词：双腔支气管导管 单肺通气 吸气峰压 肺顺应性 管端 正位与错位 

分 类 号：R655[医药卫生—外科学] R654.1[医药卫生—临床医学]