超声检查在左侧双腔支气管导管定位中的临床应用  

Clinical application of ultrasound examination in confirming position of left-sided double-lumen endobronchial tubes

作　　者：杨定东 王绍林 张晶晶 刘小彬 YANG Dingdong WANG Shaolin ZHANG Jingjing LIU Xiaobin(Department of anesthesiology,Wuhu No.2 People＇s Hospital, Wuhu 241000, China)

机构地区：[1]芜湖市第二人民医院麻醉科,安徽芜湖241000

出　　处：《皖南医学院学报》2016年第4期381-383,387,共4页Journal of Wannan Medical College

基　　金：芜湖市科技计划重点项目(2013HM24)

摘　　要：目的：探讨肺部超声检查在左侧双腔支气管导管（LDLT）定位中的作用和可行性。方法：共纳入需单肺通气的ASAⅠ~Ⅱ级胸科手术成年患者80例,男61例,女19例,年龄36~79岁,平均（62±10）岁。随机分为超声组和临床组,每组各40例。临床组通过呼吸音和气道压定位,将左侧或右侧单肺通气时仅通气侧有呼吸音且气道压〈40 cm H_2O评估为导管位置合适。超声组通过超声检查患者双侧胸膜及膈肌的相对运动及气道压定位,将左侧或右侧单肺通气时仅通气侧有胸膜和膈肌运动且气道压〈40 cm H_2O评估为导管位置合适。最后经纤维支气管镜判断导管准确位置。结果：通过纤维支气管镜验证,临床组和超声组LDLT定位合适例数分别为24例（60.0%）和33例（82.5%）,差异有统计学意义（P〈0.05）;临床组判断LDLT位置的特异度为6.25%,准确率为62.5%,阳性预测值为61.5%,而超声组特异度为28.6%,准确率为87.5%,阳性预测值为86.8%,两组准确率和阳性预测值比较差异有统计学意义（P〈0.05）。结论：超声检查肺运动联合气道压监测的方法能提高LDLT定位合适的成功率,其判断LDLT位置的准确率和阳性预测值较高,在纤维支气管镜不具备或不合适的情况下,是LDLT插管定位的另一较好选择。Objective： To assess the feasibility of lung ultrasound examination combined with airway pressure monitoring in confirming the position of leftsided double-lumen endobronchial tube（ LDLT）.Methods： Eight patients（ ASA Ⅰ-Ⅱ） undergoing elective thoracic surgery,required one-lung ventilation were randomized into the clinical method group（ Group A） and the ultrasonic method group（ Group B）（ n = 40 each）. The position of LDLT was determined by auscultation of the lungs and airway pressure in Group A.The position of the catheter was assessed as appropriate if breath sounds were auscultated only in ventilation side and airway pressure were less than 40 cm H_2O when one lung ventilation was provided.While in Group B,the position of LDLT was judged by ultrasound examination of pleural and diaphragmatic movement and airway pressure.The position of the catheter was assessed as appropriate if pleura and diaphragm moved only in ventilation side and airway pressure were less than 40 cm H_2O when one lung ventilation was provided.Finally,the catheter was positioned via fiber bronchoscopy. Results： Correct position of LDLT was 24（ 60%） and 33（ 82. 5%） for Group A and Group B,and the difference was statistically significant（ P〈0. 05）. The specificity,accuracy and positive predictive value was 6. 25%,62. 5% and 61. 5% for the clinical method group,and 28.6%,87.5% and 86.8% for the ultrasonic method group,respectively.The difference was significant regarding the accuracy and positive predictive value（ P〈0. 05）. Conclusion： Compared with the method of auscultation and airway pressure monitoring,using ultrasound examination of lung movement and airway pressure monitoring has higher successful rate in LDLT positioning,and higher accuracy and positive predictive value of position evaluation.

关 键 词：超声检查 介入性 双腔支气管导管 单肺通气 

分 类 号：R655[医药卫生—外科学]