1-双腔支气管插管(新增）.ppt

* * * A bronchial blocker is a thin catheter with a balloon at the distal tip. This catheter is placed through a standard endotracheal tube and the balloon is placed into one bronchus to block air flow to that lung. The most common bronchial blocker in use is the Arndt blocker, sold by Cook Critical Care. Cook also sells a new version, known as the Cohen blocker. The bronchial blocker sets are relatively expensive at around $123 per set. * The primary advantage of bronchial blockers is that they can be placed through a standard ET tube. After the surgery is complete, the bronchial blocker is removed but the endotracheal tube can remain in place for the remainder of the patient’s hospitalization. A bronchial blocker may also be useful for unusual situations, such as when a patient’s airway is too narrow to accommodate an endobronchial tube or when it is necessary to manage the airway through a stoma. It does have important limitations, however. Because there is no way for air in the blocked lung to exit, it takes longer for the lung to be completely deflated. It is also difficult to provide CPAP with a bronchial blocker. Several techniques have been developed but they are awkward and require practice. It is also difficult to temporarily ventilate the non-ventilated lung and impossible to switch ventilation between lungs. Finally, it is expensive for routine use. 双腔支气管插管(Double-lumen bronchial tubes, DLT) 用于胸部手术/重症患者的单肺独立,同步/非同步通气 配备有左/右肺不同型号的插管 卓越的品质增加了其安全及舒适性 1949年，Carlens设计了双腔导管用于支气管肺量的测定，称之为Carlens DLT 。是一种左侧双腔管，有F35、37和39三种规格，用红橡胶制成，目前已不使用。 1962年，发明了Robertshaw双腔管，有左侧和右侧两种，由透明塑料制成，表面有长度刻度标志，支气管套囊与近端接口为蓝色，对侧为无色透明。 Broncho-cath DLT 目前使用最多的DLT，由Mallinckrodt（万灵科）厂出品，设计上与Robertshaw DLT相似。 双腔支气管插管发展史 支气管的生理解剖 左总支气管长约5cm，与气管构成40～500角，细长 右总支气管长约2cm，与气管构成20～250角，粗 右 左 将一侧肺与另一侧肺隔开，防止健侧肺污染，避免肺内容物溢出或感染，如一侧肺部化脓性感染或发生大咯血、出血。 通气分布的控制 支气管胸膜瘘、支气管胸膜皮肤瘘 对大的传导性气道进行手术开窗治疗 巨大单侧肺囊肿或肺大泡 气管、支气管树损伤 单侧支气管肺灌注 各种尘肺、干酪性肺炎 绝对适应症 凡利于术野显露和方便手术操作者，均可视为相对适应症 胸主动脉瘤、全肺切除术、胸腔镜手术、纵隔镜检、