肺隔离技术精编版.ppt

困难气道病人的肺隔离：原则 确保肺通气 优先使用熟悉的工具建立人工气道 优先插入单腔管（气管导管） 视频喉镜直视下交换成“双腔管” 或使用“支气管阻塞导管” 困难气道病人的肺隔离 无困难通气（诱导后插管） 顺利插入双腔管 气管导管 + 支气管堵塞导管 气管导管 ? 交换双腔管 困难通气 + 困难插管（清醒插管） 气管导管 + 支气管堵塞导管 气管导管 ? 交换双腔管 气管导管-双腔管交换导管： 83 cm 困难气道病人的肺隔离 抛砖引玉 欢迎讨论 * The tip of the Arndt blocker consists of a nylon wire loop through which the bronchoscope is threaded. The bronchoscope may then be used to directly guide the Arndt blocker into position. The Cohen blocker tip can be deflected by turning a wheel at the proximal end of the blocker The Univent is a single lumen tube with an external channel that houses a built-in bronchial blocker. This blocker is composed of a malleable material that allows the preshaped tip to be positioned by applying rotational torque to the proximal end. The blocker of the Univent tube is also available separately as the Fuji Uniblocke The EZ Blocker is positioned by passing through an ETT 8 mm ID under FOB guidance until the Y-connection between the two blockers is seated on the carina. A standard endotracheal tube can be advanced into either mainstem bronchus (mainstem intubation), resulting in ventilation of only the intubated lung. The length of the cuff and the tube beyond it (4 cm) are longer in an endotracheal tube than in a DLT, so when the cuff is entirely within the bronchus (necessary for lung separation) it will often cause obstruction of the upper lobe bronchus, especially if placed on the right [30]. Specifically designed single-lumen?endotracheal/endobronchial?tubes can be used for lung isolation. These tubes can be used as an endotracheal tube and then passed into the mainstem bronchus with the FOB as needed for use as an endobronchial tube (picture 12). These tubes are useful for carinal resections. Bar graphs of the lung collapse score at 1, 5, and 10 minutes after initiation of 1-lung ventilation. Range: 0 = no collapse, to 10 = complete collapse. LCS = lung collapse scale. Figure 1 Schematic drawing of experimental preparation. (A) Clamp for initia