摘要
目的探讨用吸气峰压(Ppeak)和套囊容量变化的量化指标评估无隆突钩右双腔支气管导管(DLT)管端位置的可行性。方法拟行左侧剖胸手术的成年患者50例,静脉诱导后插入预先选定的右 DLT,吸入地氟醚维持麻醉。按纤维支气管镜确认 DLT 管端位置和通气方式将观测过程分四个阶段：第一阶段,管端位置正确,双肺通气；第二阶段,管端位置正确,右侧单肺通气(OLV)；第三阶段,管端进入右中间支气管,右侧 OLV；第四阶段,管端处在右支气管开口,右侧 OLV。每阶段机械通气15 min 后,记录 Ppeak 和分钟通气量。管端改变位置后,保持气管和支气管套囊压分别为25 cm H_2O 和20 cm H_2O,记录套囊注气量。结果与第一阶段比较,第二、三、四阶段 Ppeak 值上升(P＜0．05或0．01),第三阶段最明显；DLT 支气管套囊内压为20 cm H_2O 的注气量在第三阶段下降,第四阶段上升(P＜0．05 或0．01)。以 OLV 各阶段 Ppeak 值达到第一阶段的1．6倍,且 Ppeak 值≥127 cm H_2O,支气管套囊注气量≤第一阶段的60%作为判定管端过深的指标时,特异性达92%、预报管端错位阳性率达90%。结论单肺通气时,Ppeak 超过27 cm H_2O,并超过双肺通气时的1．6倍,支气管套囊注气量下降至双肺通气时的 60%以下,应高度怀疑右 DLT 管端发生过深移位。
Objective To investigate the feasibility of evaluating the tip position of fight-sided double-lumen endobronchial tubes （DLTs） without carinal hook by the changes of inspiratory peak airway pressure （Ppeak） and cuff volume.Methods 50 adult patients undergoing thoracic surgery were intubated with right-sided Mallinckrodt DLTs. DLTs were positioned by fihemptic bronchoscope at four stages：correct position and two lung ventilation （TLV） ;correct position and one-lung ventilation （OLV） ;malposition （the DLTs were inserted into the right middle bronchi） and OLV;malposition （the tips of DLTs were kept near the entrance of the right principal bronchi） and OLV.The patients were ventilated in a model of IPPV for 15 min and the tracheal and bronchial cuff pressure was kept 25 and 20 cm H20 at each stage respectively. Results Ppeak increased when switching from TLV to OLV, and even greater when DLTs were inserted too deep （ P 〈 0.05 or P 〈 0.01 ）. The bronchial cuff volume decreased significantly when DLTs were inserted too deep and increased much when DLTs were not deep enough （ P 〈 0. 05 or P 〈 0. 01 ）. For estimating the depth of DLT by Ppeak excesses 27 cm H2O,and there was a increase more than 60% of the baseline in Ppeak and bronchial cuff volume was less than 60% of the baseline when switching from TLV to OLV, the specificity was 92 % and positive predictive value was 90%. Conclusion If Ppeak excesses 27 cm H2O, and there is a increase more than 60% of the baseline in Ppeak and bronchial cuff volume is less than 60% of the baseline when switching from TLV to OLV, it should highly be doubted that the DLT has been inserted too deep.
出处
《河北医药》
CAS
2005年第12期885-887,共3页
Hebei Medical Journal
基金
广州市科技局重点攻关项目(No.2002-Z3-E0191)
关键词
双腔支气管导管
管端位置
吸气峰压
套囊容量
double-lumen endobronchial tube
position
inspiratory peak airway pressure
cuff volume
