【摘要】 目的　观测无隆突钩双腔支气管导管 (DLT)管端位置与吸气峰压 (Ppeak)以及肺顺应性环形状改变的关系 ,探讨用Ppeak和顺应性环的变化评估DLT管端位置的可行性。方法拟行右侧剖胸手术的成年患者 32例 ,静脉诱导后插入左MallinckrodtDLT ,吸入氧化亚氮和地氟醚维持麻醉。按纤维支气管镜 (FOB)确认DLT管端位置和通气方式将观测过程分为四个阶段 :第一阶段 (S1) ,管端位置正确的双肺通气 ;第二阶段 (S2 ) ,管端位置正确的左侧单肺通气 ;第三阶段 (S3 ) ,管端插入左下支气管 (置管过深 )的左侧单肺通气 ;第四阶段 (S4) ,管端处在左支气管开口 (置管偏浅 )的左侧单肺通气。每阶段均机械通气 15min。结果　回归方程预计插管深度与FOB检查符合者占 71 9%。S2时Ppeak值比S1时增加 5 0 8% ,肺顺应性 (Cdyn)值减少 36 2 % ;S3 时Ppeak值比S1时增加 87 4 % ,Cdyn值减少 5 6 8%。P V环曲线斜率向右明显移位 ,环体显著延长。 结论　用无隆突钩DLT行肺隔离 ,在无FOB定位的条件时 ,联合应用听诊法、回归方程预计插管深度、动态监测气道峰压和P V环的变化综合评估 ,可提高DLT管端的正确到位率。单肺通气的气道峰压超过双肺通气时的 1 6 5倍 ,且气道峰压超过 2 5cmH2 O ,应高度怀疑DLT管端发生过深移位。更多还原

【Abstract】 Objective To observe the relationship between the tip position of double lumen endobronchial tubes(DLTs) without carinal hook and the changes of inspiratory peak airway pressure(Ppeak)together with lung compliance loop,and to study the feasibility of evaluating the tip position of DLTs by the changes of Ppeak and lung compliance loop.Methods 32 adults undergoing thoracic surgery were intubated with left-sided Mallinckrodt DLTs.DLTs were positioned by fiberoptic bronchoscope (FOB)at four stages:correct position and two lung ventilation(TLV), correct position and one lung ventilation(OLV),malposition(the DLTs were inserted into the left lower bronchi)and left lung ventilation,and malposition(the tips of DLTs were kept near the entrance of the left principal bronchi)and one lung ventilation.The patients were ventilated in a modole of IPPV for 15 min at each stage respectively.Results The incidence that the anticipated depth of tube placement according to the regressive equation corresponded with FOB positioning was 71.9%.When switcheing from TLV to OLV in correct DLT position,Ppeak increased by 50.8% and lung compliance decreased by 36.2%,which were even greater and the slope of P-V curve was reduced and the P-V loop prolonged when DLTs were inserted too deap.Conclusion In case of positioning DLT without FOB,the incidence of coorectly positioning DLT without carinal hook is improved by combined adjustment of ausculation,calculation of DLT depth using regressive equation and monitoring of Ppeak and P-V loop.If there is a more than 65% increases of the baseline in Ppeak and Ppeak excesses 25 cmH 2O when switching from TLV to OLV,one must highly doubt that the DLT has been inserted too deap.更多还原