单肺通气时气道压力变化及其临床意义的探讨  

Airway Pressure Changes and Meanings during One-lung Ventilation

作　　者：刘继[1] 李杰胜[1] 赵如明[1] 邹学超[1] 

机构地区：[1]上海市肺科医院麻醉科,200433

出　　处：《临床麻醉学杂志》2000年第10期486-487,共2页Journal of Clinical Anesthesiology

摘　　要：目的 :观察双腔支气管导管 (DLT)插管后 ,由双肺通气 (TLV)改为单肺通气 (OLV)时气道压力变化 ,并探讨其在判断DLT位置的意义。方法 :选择纤支镜检查阴性、痰量较少、肺功能正常的肺手术病人 35例 ,依次行TLV和OLV(非手术侧 ) ,并记录气道峰压、平台压 ,再行纤支镜检查。结果 :(1)由TLV改为OLV后 ,DLT位置异常 (10例 )和正常时的气道峰压、平台压分别增加 74%、6 7%和 5 2 %、45 % ;(2 )参照Griner的方法 ,以 3 4、3 9、4 4kPa作为OLV时气道峰压的上限值时 ,分别可诊断 6 7%、39%、14%的DLT位置异常 ,诊断准确率分别为 83 %、80 %、75 %。结论 :气道压力的变化在判定DLT位置时有一定的参考价值。选择 3 4kPa作为OLV气道峰压的上限值时 ,其诊断位置异常的阳性率和诊断符合率相对较高。Objective:To observe airway pressure changes and meanings during transition from two lung to one lung ventilation in patients intubated with a double lumen endotracheal tube(DLT).Methods:35patients scheduled for lung surgery were selected randomly after DLT intubation and the pressure values during OLV were compared with those observed during TLV.Fibrobronchoscopy(FBS) was performen in all cases.Results:FBS revealed 25 well positioned and 10 malpositioned DLTs.Their Ppeak,Pplateau increased by a mean of 52%,45% and 74%,67%.Using 3 4,3 9,4 4kPa as the OLV Ppeak upper limits,the percentages of DLT malposition were 67%,39% and 14% respectively.Diagnostic accuracy was 83%,80%and 75% respectively.Conclusion:Using 3 4kPa as the upper limit to detect DLT malposition has higher sensitivity and accuracy.

关 键 词：单肺通气 气道阻力 支气管镜检查 

分 类 号：R655.4[医药卫生—外科学]