纤维支气管镜在开胸术中应用.doc

纤维支气管镜在开胸术中应用（河北省唐山市胜利路65号唐山市人民医院 河北 唐山 063000） 【摘要】目的: 应用纤维支气管镜评价常规双腔支气管导管插管定位的准确性。方法: 60 例择期行开胸手术, 术中需要单肺通气的胸部肿瘤患者, ASA 分级I～II 级。麻醉诱导后由一位麻醉医师选择并插入一次性PVCRobertshaw双腔支气管导管, 先用听诊法确定导管的位置, 再由另一位麻醉医师用纤维支气管镜（fiberoptic bronchoscope, FOB）确定和调整导管的位置, 记录结果。当病人由平卧位改为侧卧位时, 再进行听诊和FOB 检查, 记录结果。当导管位置偏离正确位置0. 5cm 以上时认为是导管错位。同时记录单肺通气时的气道峰压（Paw）、血氧饱和度（SPO2 ）。结果: 在平卧位和侧卧位时, FOB检查时有71.3%和45. 0%的导管位置需要重新定位。平卧位导管错位时, 插入过深和插入过浅发生率相似, 侧卧位以插入过浅为主。右侧双腔管较左侧双腔管更易出现错位。结论: 使用Robertshaw 导管行肺隔离时, 在病人平卧位和侧卧位时用纤维支气管镜对导管定位更为准确、可靠。 【关键词】双腔支气管导管;纤维支气管镜;定位 The role of fiberoptic bronchoscope in the positioningof double- lumen endobronchial tube Zou guohongGan jianhui 【Abstract】Objective： To evaluate the accuracy of positionning double-lumen tube （DLT） intubation with fibreoptic bronchoscopy. Methods: One hundred and twenty ASA I～II patients who underwent thoracic operation and required one lung ventilation （OLV ）were studied. After anesthesia induction, a selected Portex Robertshaw DLT was inserted by one anesthetist. Bronchoscopy was performed by another anesthetist after intubation and auscultative verification of correct placement and after patient positioning for thoracotomy. A DLT was considered malplacement when its deviation 0.5cm. Then the results were recorded. Meanwhile Paw and SPO2 during OLV were recorded.Results: After blind intubation and patient positioning, DLT was found to be displaced in 71.3% and 45.0% by Bronchoscopy. Distal malposition was similar with proximal malposition after intubation. But after positioning, proximal malposition occurred more frequently than distal malposition. Right- sided DLT was significantly more likely to be displaced than left- sided DLT.Conclus ion:The use of FOB as a diagnostic tool in positioning the Robertshaw PVC- DLT both after blind intubation and after patient positioning is reliable and necessary. 【Key words】Key words Robertshaw DLT;FOB; Positioning 【中图分类号】R655 【文献标识码】A【文章编号】1008-6455（2011）06-0160-02 目前, 单肺通气是通过双腔支气管导管