腹腔镜手术中气管导管移位的临床观察  

Clinical observance of endotracheal tube displacement during laparoscopic surgery

作　　者：唐晨程 张晓庆[1] 

机构地区：[1]同济大学附属上海同济医院麻醉科,200065

出　　处：《临床麻醉学杂志》2014年第12期1184-1186,共3页Journal of Clinical Anesthesiology

摘　　要：目的：观察腹腔镜手术术中气管导管移位的特点，探讨气腹及不同体位对气管导管移位的影响。方法妇科腹腔镜手术患者60例（A 组），腹腔镜胆囊切除术患者60例（B 组），气腹压力均为13 mm Hg。于气管插管后（T1）、气腹平卧位（T2）、气腹调节体位后（A 组：头低足高30°，B 组：头高足低30°）（T3）、术中即气腹调节体位后30 min （T4）、气腹结束后体位复原前（T5）、气腹结束后平卧位（T6）测量患者气管长度（Lac）、隆突至气管导管末端距离（Lab）、声门至气管导管末端距离（Lbc）等，记录各时点气管导管套囊压力（Pc）。结果与 T1时比较，T2～T4时两组 Lac 和 Lab 明显缩短（P＜0.05），T5、T6时恢复至 T1水平；相同时点两组 Lac、Lab 和 Lbc 差异均无统计学意义；T2～T4时两组 Pc 明显增高（P＜0.05）。B 组有2例气管导管扭曲打折；气管导管误入右侧支气管8例，其中 A 组5例，B 组3例。结论气腹可导致气管导管向隆突方向移位，严重时可进入一侧支气管，但体位变化未引起气管导管显著移位；气管导管移位受套囊的阻挡，有致气管导管扭曲打折可能。Objective To observe the displacement of endotracheal tube during laparoscopic surgery,explore whether pneumoperitoneum and body position are associate with the displacement. Methods A total of 120 female patients were included in this study,60 cases underwent gynecological lapa-roseopic operation as group A,and 60 cases had laparoscopic cholecystectomy as group B.Intrabdominal pressure was maintained in 13 mm Hg during the operation.The length of trachea（Lac）,the length from carina to the tip of an endotracheal tube（Lab）,the length from glottis to the tip of an endotracheal tube （Lbc）and the cuff pressure （Pc）were measured after endotracheal intubation （T1 ）,insufflation in the su-pine position （T2 ）,insufflation in the Trendelenburg or reverse Trendelenburg position （T3 ）,30 minutes after insufflation in the Trendelenburg or reverse Trendelenburg position （T4 ）,deflation in the Trendelen-burg or reverse Trendelenburg position （T5 ）,deflation in the supine position （T6 ）.Results In both groups,Lac and Lab at T2-T4 were significantly shorter than those at T1 （P〈0.05）,but they were back to the original level at T5 ,T6 .Pc were higher at T2-T4 （P〈0.05）.Lac,Lab and Lbc didn’t show significant difference between the two groups at T1-T6 .At T2 and T3 ,in group B endotracheal tube distorting occurred in 2 patients and tube into right bronchus occurred in 3 patients,while tube into right bronchus occurred in 3 patients in group A.Conclusion Pneumoperitoneum can cause endotracheal tube displacement to-ward to carina.Body position unlikely to change endotracheal tube position.The displacement was blocking by cuff could cause distorting of the tube.

关 键 词：气腹 体位 气管导管移位 并发症 

分 类 号：R614[医药卫生—麻醉学]