8-双腔管直径比较.pdf

Insertion of a Double Lumen (Tracheobronchial) Tube W. John Russell August 2005 The blind technique for insertion of double-lumen (tracheobronchial) tubes was described in 1992. Since then this technique has been modified and widely taught. There are several important steps in the effective use of this technique. These are:- a) Recognition that the diameter of the bronchus (usually the left) is a crucial determinant of success. This size can be found from the standard P-A chest X-ray, which magnifies the air bronchogram by about 10% as the bronchi are about 6 inches from the plate which is positioned 6 feet from the X-ray source. Unfortunately the size in French gauge does not indicate the diameter of the bronchial segment of the tube. The table below gives a guide to the selection of the tube for the left main bronchus (taken from Russell WJ, Strong TS. Dimensions of double-lumen tracheobronchial tubes. Anaesth. Intens Care 2003; 31:50-53.) Table 1 Relationship between left main bronchial measurement and tracheobronchial tube selection Measured Diameter of Left Main Bronchus on P-A Chest X-ray Measured 9(8.1) 10(9.0) 11(9.9) 12(10.9) 13(11.7) 14(12.6) (Actual) Diameter mm Sheridan NA 28 - 35 37/39 4 1 Mallinckrodt 28 32 - 35 37/39 4 1 Portex NA NA 35 37 39/4 1 - Riisch NA NA NA 35 37/39 4 1 b) Once the patient is anaesthetised and paralysed, the selected tube is inserted into the trachea until the bronchial cuff is about 3 cm below the vocal cords. This should leave the tube about 4-6 cm abo