头颈部位置改变对可视双腔气管导管位置的影响  

Impact of Head and Neck Position Change on the Position of Visual Double-lumen Tracheal Tube

作　　者：刘涛[1] 罗太君 陈玢[1] 曹晓曼 刘伟[1] Liu Tao;Luo Taijun;Chen Bin;Cao Xiaoman;Liu Wei(Department of Anesthesiology,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院麻醉科,北京101149 [2]北京积水潭医院麻醉科

出　　处：《结核病与胸部肿瘤》2020年第3期239-242,共4页Tuberculosis and Thoracic Tumor

摘　　要：目的探讨头颈部位置变动对可视双腔气管导管(DLT)移位的影响。方法选取2018年2月一2018年7月在北京胸科医院行胸科手术的患者40例,静脉麻醉诱导后置入DLT,所有患者均采用可视F35号左侧DLT。患者头部处于正中位固定气管导管,随后在可视DLT的引导下,联合纤维支气管镜,分别测量患者头颈部处于正中位、前屈位、后仰位、左侧位(左偏90°)及右侧位(右偏90°)时双腔气管右侧导管尖端与隆突的距离。结果头颈部屈曲引起DLT向内移位(5.6±2.0)mm,头颈部后仰引起DLT向外移位(12.9±4.3)mm,患者头颈部位于前屈位时双腔管移动的距离明显小于头颈部后仰时双腔管移动的距离(t=-15.48,P<0.01);头颈部左偏引起DLT向外移位(4.3±1.3)mm,头颈部右偏引起DLT向外移位(4.2±1.3)mm,患者头颈部左偏与右偏时,可视DLT的移动距离未见明显差别;气管导管移位多少与患者性别无关。结论可视化技术展示头颈部移动引起气管导管位置的改变,为临床麻醉提供参考。Objective To investigate the impact of head and neck position changes on the displacement of visual double lumen bronchial tube.Methods 40 patients scheduled for thoracic surgery from February to July 2018.All the patients were intubated with 35-Fr visual double-lumen tube(DLT)after the induction of anesthesia.Visualdouble-lumen bronchial tube combined with fiberoptic bronchoscopy was used to measure tracheal tube displacement.The distance between the tip of the right lumen of the double lumen bronchial tube and the tracheal carina was first measured with the head and neck of the patient in the neutral position.The distance between the tip of the right lumen of the double lumen bronchial tube and the tracheal carina was then measured in the four other positions including the patient's head and neck rotated 90°to the right,head and neck rotated 90°to the left,head and neck flexed,and as well as head and neck extended.Results Head and neck flexion caused an inward migration of the L-DLT(5.6±2.0)mm,head and neck extension caused an outward displacement(12.9±4.3)mm,the moving distance of the L-DLT in head and neck flexion was significantly smaller than head and neck extension;head and neck rotated 90°to the left caused an outward displacement(4.3±1.3)mm,head and neck rotated 90o to the right caused an outward displacement(4.2±1.3)mm,there was no significant difference in displacement of L-DLT between left and right deviation.Tracheal tube displacement had no correlation with gender.Conclusion Visual technology displayed that head and neck movement caused changes in the position of the tracheal tube,and provided reference for clinical anesthesia.

关 键 词：全身麻醉 可视双腔气管导管 体位 头颈部 移位 

分 类 号：R73[医药卫生—肿瘤]