气囊测压法在左侧双腔支气管导管定位中的应用  

THE APPLICATION OF BRONCHUS CUFF PRESSURE MEASUREMENT FOR POSITIONING OF THE LEFT SIDE DOUBLE-LUNEN TUBE

作　　者：刘志永[1] 丁翠青[1] 

机构地区：[1]河北医科大学附属哈励逊国际和平医院麻醉科,河北省衡水市053000

出　　处：《中国煤炭工业医学杂志》2013年第12期1943-1945,共3页Chinese Journal of Coal Industry Medicine

摘　　要：目的本研究拟评估采用左侧支气管气囊测压法行左侧双腔支气管导管插管的定位效果。方法拟在全麻下行择期胸科手术患者91例，随机分成二组：指示球囊组（Ⅰ组，n=46），听诊组（Ⅱ组，n=45）。麻醉诱导成功达到插管条件后用常规方法行左侧双腔支气管导管插管。定位方法Ⅰ组中当插入后继续向前推动导管直至遇到阻力时停止，将支气管指示球囊通过三通连接压力表，并通过三通缓慢注入1．0～2．0ml空气使气囊压力达到30cm H2O，然后缓慢回退导管直至压力表显示为初始值一半时停止，抽空支气管气囊的空气，将导管向前推进1cm，重新将气囊充入气体，完成定位。Ⅱ组中使用传统听诊法进行判断定位。结果应用纤维支气管镜验证二组导管定位情况，Ⅰ组的成功率为95．7％，导管处于理想位置的为34例，Ⅱ组成功率为66．7％，导管处于理想位置的为10例，Ⅰ组成功率和处于理想位置的人数均优于Ⅱ组（P〈0．05）。结论左侧支气管气囊测压法操作简单、成功率高，在无纤维支气管镜应用条件时可作为其替代方法，具有明显的临床指导意义。Objective To evaluate the application of the left pilot balloon pressure of the double lumen tube for positioning left side DLT（DLT, double lumen tube）. Methods Ninety one patients undergoing elective thoracic surgery were enrolled in our study. They were divided randomly into two groups., pilot balloon group（group Ⅰ,n = 46） and auscultation group（group Ⅱ ,n = 45 ）. After the induction of anesthesia, the patients were intubated with left side DLT by using conventional approach. Positioning methods in group Ⅰ：the left side DLT was inserted deeply until moderate resistance was felt and connected the pressure gauge through a three- way stopcock, and then injected 1.0-2.0ml air into left bronchial cuff from the stopcock until the cuff pressure reached 30cmH2O. And withdrawed the DLT until the left cuff pressure decreased to the half of the initial value,then deflated the cuff, and advanced the DLT about lcm and reflated the left cuff again, then the positioning of the left side DLT was completed. Positioning methods in group Ⅱ ： the left side DLT was positioned by using the traditional auscultation. Results The fiberoptic bronchoscope was used to investigate the positioning results of two groups. The success rate was 95.7 percentages and 66.7 percentages in group Ⅰ and group Ⅱ , respectively. There were 34 patients at the ideal position in group Ⅰbut only 10 patients in groupⅡ , the success rate and the number of patients at the ideal position in group Ⅰ were better than those in group Ⅱ. Conclusion Compared to the traditional method, manometry of the left bronchial cuff pressure is almost not affected by patient% position and pulmonary disease（ex- cept the anatomy change of the tracheobronchial tree）, and has relatively lower time cost. It can act as an alternative method when the fiberoptic bronchoseope is unavailable.

关 键 词：双腔支气管导管 气囊压力 定位 单肺通气 

分 类 号：R768[医药卫生—耳鼻咽喉科]