预观察右上叶支气管开口解剖对右双腔支气管导管对位的临床意义

发布时间：2018-02-01 07:08

本文关键词： 支气管镜右双腔支气管导管右上叶支气管开口右主支气管导管对位解剖学人　出处：《解剖学报》2017年02期 　论文类型：期刊论文

【摘要】：目的探讨以纤维支气管镜预观察右上叶支气管开口解剖方位,对插右双腔支气管导管(R-DLT)对位的临床意义。方法选择插R-DLT成年患者160例,随机分为实验组和对照组,每组80例。实验组病例麻醉诱导后预先行支气管镜检查,主要测量右主支气管长度及右上叶支气管开口在右主支气管横切面的方位(以患者正前方12点钟位置为0度起点,按顺时针增大)。两组按常规方法将R-DLT插入右侧支气管,之后以纤维支气管镜检查调整导管位置。实验组按之前测定的支气管解剖调整导管深度并作适当的旋转,对照组只调整导管深度使蓝色的支气管套囊上缘在隆突之下见到。然后纤维支气管镜改从右管腔插入通过导管的侧孔查看右上叶支气管开口的对位情况,没有进一步调整就能够看到右上叶支气管开口即为初步对位成功。最后适当微调导管,直至能看清右上肺尖段、后段及前段3个开口。比较两组初步对位成功率以及插管失败率。结果实验组右主支气管长度(2.29±0.58)cm,其中短于1cm的有2例,占2.5%;右上叶支气管开口在右主支气管横切面方位(94.5±8.3)°,其中有4例(5.0%)明显偏前或偏后。实验组右上叶支气管开口初步对位成功实验组有77例(96.3%),而对照组为62例(77.5%),组间差异显著(P0.05)。两组各有1例插管失败,占1.25%,均为右上叶支气管开口与隆突距离较近(1cm)。结论预先以纤维支气管镜查看右支气管解剖有助于提高插R-DLT初步对位的准确性,并利于插管前发现右上叶支气管开口变异而选择合适的导管具有重要意义。
[Abstract]:Objective to investigate the anatomic orientation of the right upper lobe bronchus by fiberoptic bronchoscopy. Methods 160 adult patients with R-DLT were randomly divided into experimental group and control group. There were 80 cases in each group. After anesthesia induction, bronchoscopy was performed in the experimental group. The length of the right main bronchus and the orientation of the right upper lobe bronchus orifice on the transverse plane of the right main bronchus were measured. The R-DLT was inserted into the right bronchus in both groups according to the routine method. The position of the catheter was adjusted by fiberoptic bronchoscopy. The depth of the catheter was adjusted and rotated according to the previously measured bronchial anatomy in the experimental group. The control group only adjusted the depth of the catheter so that the blue upper margin of the sleeve sac was seen under the Carina. Then the fiberoptic bronchoscope was inserted through the lateral hole of the catheter to examine the position of the right upper lobe bronchus opening from the right lumen. Without further adjustment, the opening of the right upper lobe bronchus was initially successful. Finally, the catheter was fine-tuned until the apical segment of the right upper lung could be seen. Results in the experimental group, the length of the right main bronchus was 2.29 卤0.58 cm, of which 2 cases were shorter than 1 cm. 2. 5%; The right upper lobe bronchus origination was 94.5 卤8.3 掳on the transverse plane of the right main bronchus. There were 77 cases of successful right upper lobe bronchus opening in the experimental group, while 62 cases in the control group were 77.5%). There was a significant difference between the two groups (P 0.05). One case (1.25%) failed intubation in each group. The distance between right upper lobe bronchus opening and Carina was close to 1 cm. Conclusion the preliminary accuracy of R-DLT can be improved by examining the anatomy of right bronchus by fiberoptic bronchoscopy. It is important to find the variation of the right upper lobe bronchus before intubation and select the appropriate catheter.
【作者单位】：温州医科大学附属浙江省台州医院麻醉科;
【分类号】：R614
【正文快照】： 双腔支气管导管(double-lumen endobronchialtube,DLT)的良好对位对胸科手术时单肺通气和肺隔离至关重要。右双腔支气管导管(right DLT,R-DLT)较左双腔支气管导管(left DLT,L-DLT)对位困难。因为右上叶支气管开口距气管隆突很近,仅1.5~2.0cm[1]。R-DLT正确位置的安全范围小,易

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