次侧听诊法在右双腔支气管导管快速定位中的应用  

Application of Minor Auscultation Method in Positioning of Right Double Lumen-endobronchial Tube

作　　者：李文媛[1] 汪小海[1] 骆璇[1] 陆利冲[1] 李浩[1] 

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008

出　　处：《医学研究杂志》2012年第7期139-143,共5页Journal of Medical Research

摘　　要：目的评价次侧听诊法在右双腔支气管导管(R-DLT)快速定位中的应用。方法全麻下择期胸科手术患者40例(ASAⅠ～Ⅱ,150～178cm,29～79岁),随机分为对照组(C组)和试验组(E组),每组各20例。前者采用传统听诊法,后者采用次侧听诊法,即右DLT插入气管后,听诊左肺,边予肺通气边推进导管,当左侧呼吸音突然减弱时视为导管刚进入右主支气管,继续推进3.5/3.4cm(即导管前端至支气管套囊近端边缘的距离),两组定位后采用经纤维支气管镜(FOB)确认并调整。该实验中,需记录:①两组DLT插管及定位良好时所需时间;②两组定位好及改变体位后FOB检查导管移位并调整的次数;③两组单、双肺通气后10 min时动脉血气值;④术后喉部水肿、气道黏膜损伤及声音嘶哑的发生率。结果两组患者一般情况、插管时间、PaO2、PaCO2、pH、术中调整DLT次数及操作损伤人数均无统计学差异(P>0.05)。与C组相比,E组DLT定位时间(154.5s)及一次性定位成功率(95%)明显优于C组(216.7s,10%)(P<0.05)。结论次侧听诊法操作简单,定位快速准确,具有很好的临床实用性,且不增加插管后并发症。Objective To present a minor auscultation method and evaluate its feasibility in positing of right double lumen - endo- bronchial tube （ R - DLT）. Methods A total of fourty patients （ ASA Ⅰ～Ⅱ , 150 - 178 cm, aged 29 - 79 years old） requiring elective thoracic surgery undergoing general anesthesia were enrolled in this study. All patients were intubated with a R - DLT. they were randomly divided into control group （ Group C） and experimental group （ Group E） （ n = 20, each group）. The former was applied with traditional positioning method, and the latter was adopted with minor auscultation method which was intubated with R - DLT gradually and received auscultation on the left anterior of chest simultaneously, then the R - DLT was introduced another 3.4/3.5cm when the breath sounds sud- denly weakened. In this study, the followings were measured ：（~time required to position each tube satisfactorily ; ~frequency of malposi- tion with fiberoptic bronchoscopy （FOB） before and during surgery; （~arterial blood gas （ABG） after DLT and OLVlOmin; ~）glottal edema, trachyphonia and damage of airway mucosa. Results We found no difference in general condition, PaO2 , PaCOz , pH, malposi- tion frequency after lateral position and numbers of patients with glottal edema, damage of mucosa after tube withdrawing between the groups （ P 〉 0.05 ）. Time required for tube posiing of Group E （154.5s） was significantly lower than Group C （216.7s） （ P 〈 0. 05 ） , and had higher success rates （95% vs 10% ） （P 〈 0.05）. Conclusion Minor auscultation method is superior to traditional positioning method in the required time for initial positioning, and is characterized by simplicity of operation as well as cause little hurt to mucosa and glottis.

关 键 词：胸科手术 双腔支气管导管 听诊法 导管定位 

分 类 号：R655[医药卫生—外科学]