回退法在左侧双腔支气管导管定位中的应用  

Positioning of Left-sided Double-lumen Endobronchial Tubes by Withdrawing Catheter

作　　者：王玉[1] 赵为禄[2] 

机构地区：[1]江西省胸科医院麻醉科 [2]南昌大学第一附属医院麻醉科,南昌330006

出　　处：《南昌大学学报（医学版）》2013年第4期50-53,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的探讨在左侧双腔支气管导管管径与患者左主支气管内径一定匹配的前提下,导管进入左主支气管遇到阻力后,直接将导管回退一段特定距离,使导管准确定位的可行性。方法将100例需采用左侧双腔支气管导管行肺隔离术的患者按随机数字表法分为2组:A组和B组,每组50例。2组患者术前均行CT测量左主支气管内径,选择相应型号导管。A组采用回退法定位,B组采用常规的听诊法定位。用纤维支气管镜检查2组定位情况,并调整导管至最佳位置。分别记录导管以回退法、听诊法、经FOB调整至最佳位置后的置管深度,观察2组患者定位满意率和错位率、定位所需时间、气道黏膜损伤发生率的情况。结果 A组导管定位满意率明显高于B组(P<0.01)、错位率明显低于B组(P<0.01)、导管定位深度与最佳位置的距离明显小于B组(P<0.01)、定位所需时间明显短于B组(P<0.01)、气道黏膜损伤发生率明显低于B组(P<0.05)。结论回退法用于左侧双腔支气管导管定位,与听诊法比较,准确性较高,定位时间短,气道黏膜损伤率较低,有临床使用价值。Objective To evaluate the feasibility of withdrawing the catheter a specific distance after the catheter encountering resistance in left main bronchus in positioning of left-sided double-lumen endobronchial tubes under the premise of the tube size matching for the left mainstem bronchial diameter. Methods One hundred patients who needed lung isolation with left-sided double-lumen tubes were randomly divided into two groups： with 50 patients in each group.The left mainstem bronchial diameter was preoperatively measured by CT to choose the appropriate catheter.The left-sided double-lumen endobronchial tubes were positioned by withdrawing the catheter in group A and by conventional auscultation in group B.The position of tubes were observed by a branchofiberoscope and then were adjusted into the best position.The depth of tube placement was recorded and the satisfaction rate,malposition rate,positioning time and incidence of airway mucosal injury were observed in both groups.Results Compared with group B,the satisfaction rate significantly increased but malposition rate,distance between catheter positioning depth and the best position,positioning time and incidence of airway mucosal injury obviously decreased in group A（P＆lt;0.05 or P＆lt;0.01）.Conclusion Withdrawing the catheter results in higher accuracy,shorter positioning time and lower incidence of airway mucosal injury than conventional auscultation in positioning of left-sided double-lumen endobronchial tubes.

关 键 词：肺隔离术 左侧双腔支气管导管 定位 回退法 纤维支气管镜 

分 类 号：R614[医药卫生—麻醉学]