支气管导管插管深度与特定体表标志之间关系的临床应用研究  

Clinical study on relationship between bronchial intubation depth and specific body surface symbol

作　　者：颜景佳[1] 孙加晓[1] 黄燕芳[1] 江长城[1] 

机构地区：[1]福建医科大学附属泉州第一医院麻醉科

出　　处：《临床麻醉学杂志》2015年第10期969-972,共4页Journal of Clinical Anesthesiology

基　　金：福建省泉州市科技局科研基金(2013Z65)

摘　　要：目的评价双腔支气管导管（double-lumen endobronchial tube,DLT）插管深度（Y）与甲状软骨水平至剑突距离（X）之间关系,判断双腔支气管插管深度的可行性和准确性。方法选择择期行胸科手术患者441例,男232例,女209例,年龄62~84岁,ASAⅠ~Ⅲ级,按随机数字表法分为四组：男性右DLT组（MR组,118例）,女性右DLT组（FR组,107例）,男性左DLT组（ML组,114例）和女性左DLT组（FL组,102例）。测量患者甲状软骨水平至剑突距离（X）,常规麻醉诱导后插入双腔气管导管,插管深度根据本研究组五年来研究得出的简化公式确定拟插管深度（Y）,简化公式为1 YMR=XMR＋2.8;2 YFR=0.95XFR＋2.8;3 YML=XML＋2.1;4 YFL=0.97XFL＋2.1。然后再通过纤维支气管镜（FOB）证实或进行微小调节。结果四组DLT插入的适宜深度（Y）和患者的年龄无显著相关性;但和患者的身高、性别有显著相关性（P〈0.05）。其中MR组118例中有5例（4.24%）插管过深,但均不超过1cm,经调整退出后位置恰当;FR组107例中有5例（4.67%）插管过深,但均不超过1cm,经调整退出后位置恰当;ML组114例中有4例（3.50%）插管未到位（不超过1.5cm）,经调整进一步插入后位置恰当;FL组102例中有4例（3.92%）插管未到位（不超过1.5cm）,经调整进一步插入后位置恰当。四组总有效率为95.9%。结论测量体表甲状软骨水平至剑突距离可预计指导双腔支气管导管的插管深度,且和FB的定位高度一致,可作为双腔支气管插管时的参考。Objective To detect the relationship between double-lumen tube（DLT）intubation depth（Y）and the distance from thyroid cartilage to the xiphoid（X）and evaluate if it can be applied to deduce the double-lumen tube intubation depth.Methods Four hundred and forty-one patients scheduled for thoracic operation（male 232 cases,female 209 cases,aged 62-84 years,ASA Ⅰ-Ⅲgrades）were randomly divided into four groups,male right DLT group（group MR,n=118）and female right DLT group（group FR,n=107）;male left DLT group（group ML,n=114）and female left DLT group（group FL,n=102）.Before induction,the distance（X）from thyroid cartilage to the xiphoid was measured.DLT was inserted after routine anesthetic induction.The intubation depth was determined according to the simplified formula of the study group of five years’ research（Y）,which was1 YMR=XMR＋2.8;2 YFR=0.95XFR＋2.8;3 YML=XML＋2.1;4 YFL=0.97XFL＋2.1.Fiberoptic bronchoscopy（FOB） was introduced to verify the position or manipulate minorly.Results The suitable depth of each DLT insertion depth（Y）were not correlated with the patients age,body weight.Otherwise,there was significant correlation between the depth and patient’s height or gender（P〈0.05）.The tube were intubated deeply（not more than 1cm in 5cases of group MR（4.24%）and 5cases of group FR（4.67%）.In 4cases of group ML（3.50%）and 4cases of group FL（3.92%）,the tip of tube were not in the right place（less than 1.5cm）.Then adjusted to the appropriate position.Effective rate of all cases was 95.9%.Conclusion Distance from thyroid cartilage to the xiphoid can be used to predict the appropriate intubation depth of DLT.This method is highly consistent with the detection of FOB and should be considered in DLT intubation.

关 键 词：双腔支气管导管 支气管插管 体表测量 胸科手术 

分 类 号：R614[医药卫生—麻醉学]