改良单腔气管导管引导法对Univent管放置成功率的影响  

The influence of modified single-lumen endotracheal intubation on success rate of Univent tube placement

作　　者：刘瑶[1] 鄢建勤[1] 郭曲练[1] 

机构地区：[1]中南大学湘雅医院麻醉科,长沙市410008

出　　处：《临床麻醉学杂志》2012年第4期321-323,共3页Journal of Clinical Anesthesiology

基　　金：湖南省科技厅科技计划一般项目编号(2008JT3012)

摘　　要：目的评价改良单腔气管导管(ETT)引导法对Univent管左主支气管放置成功率的影响。方法需左侧肺萎陷的择期胸科手术患者80例,随机均分为改良组和常规组。气管插管前,将前端呈135°弯曲的Univent管放置于ETT(ID8.5mm)内,Univent管前端弯曲方向与ETT弯曲方向一致。改良组与常规组的主要不同点在于:内含Univent管的ETT过声门后即向左旋转90°(Univent管随ETT也向左旋转90°),两者向下推进至隆突,使ETT前端开口正对左主支气管口,然后将Univent管继续插入约5cm,ETT退至22～24cm处,用纤维支气管镜(FOB)检查Univent管是否进入左主支气管,并将Univent管调至最佳位置。记录Univent管试插次数,放置到最佳位置所需时间(从暴露声门开始),以及气道黏膜有无损伤。结果改良组Univent管一次试插成功率明显高于常规组(100%vs.60%,P<0.01);放置时间改良组明显短于常规组[(4.0±1.5)minvs.(10.0±5.5)min,P<0.01];气道黏膜损伤发生率改良组明显低于常规组(6.5%vs.17.5%,P<0.05)。结论改良ETT引导法使Univent管更容易被放置到左主支气管。Objective To assess the influence of modified single-lumen endotracheal tube-guided intubation on the success rate of the left mainstem bronchus（LMB） placement of Univent tube.Methods Eighty adult patients scheduled for thoracic surgery requiring left lung collapse were randomly assigned to two groups：the modified group and the traditional group.Before tracheal intubation,the Univent tube was placed and fixed in the lumen of a 8.5 mm internal diameter endotracheal tube（ETT）,and the distal curve direction of Univent tube was consistent with the curve direction of ETT.The main difference between modified group and traditional group was：after ETT and Univent tube passed through the vocal cord,both of them were rotated into left 90° and pushed down to the carina.Keep advancing the Univent tube for about 5 cm and withdraw the ETT till 22-24 cm at the incisor teeth.LMB insertion of the Univent tube was confirmed through fiberoptic bronchoscope and was adjusted to an optimal position.The number of attempts required for successful LMB placement of Univent tube,the time from visualization of the vocal cord to optimal position of Univent tube,and airway mucus injury were recorded.Results The success rate of Univent tube insertion into the LMB at the first attempt in modified group was significantly higher than that in traditional group（100% vs.60%,P〈0.01）.The placement time in modified group was significantly shorter than that in traditional group（4.0±1.5 min vs.10.0±5.5 min,P〈0.01）,The incidence of airway mucus injury in modified group was significantly lower than that in classic group（6.5% vs.17.5%,P〈0.05）.Conclusion Modified endotracheal tube-guided intubation could facilitate the left mainstem bronchus placement of Univent tube.

关 键 词：UNIVENT管 单腔气管导管 肺隔离技术 

分 类 号：R614[医药卫生—麻醉学]