摘要
目的观测在右侧卧位下,吸气峰压联合PETCO2的变化预判右双腔支气管导管(DLT)管端位置的可行性。方法 110例行胸科手术患者插入Mallinckrodt右DLT,在侧卧位后发生导管过深移位共25例。以纤维支气管镜(FOB)确认DLT管端位置和通气方式将观测过程分为正位双肺通气(S1)、右侧过深单肺通气(S2)及右侧正位单肺通气(S3)三个阶段,每阶段均机械通气15 min。结果 S2的Ppeak比S1增加75.5%,S3比S1仅增加44.1%;S2的PETCO2比S1下降17.5%,S3比S1仅减少8%。以单肺通气时的Ppeak≥S1Ppeak的1.6倍,PETCO2值比S1下降10%,结合OLV时的Ppeak达到24 cm H2O作为判定管端错位的截止值,特异性和预测阳性率分别达到85.7%和90%。结论侧卧位下,用无隆突钩DLT行肺隔离,联合运用动态监测气道峰压和PETCO2的变化综合评估,可提高DLT管端的正确到位率。
Objective To observe the feasibility of evaluating the tip position of right - sided double - lumen endobronchial tubes（DLTs） with the changes of inspiratory peak airway pressure and PETCO2. Methods 110 young and middle ages underwent thoracic surgery were intubated with right - sided Mallinckrodt DLTs. There were 25 cases that the DLTs were inserted into the right lower bronchi when the patients were put in the lateral position. DLTs were positioned by the fiberoptic bronchoscope（FOB） at three stages：correct position and two lung vertilation, malposition and right lung vertilation in the lateral position, and correct position and right lung vertilation in the lateral position. The patients were ventilated in the model of IPPV for 15 minute at each stage respectively. Results S2 Ppeak was in- creased by 75.5% higher than S~, S3 was only increased by 44. 1% higher than S,; S2 PETCO2 was decrease by 17. 5% lower than $1, $3 was only decrease by 8% lower than S,. （p 〈0. 01 ）. With a more than 60% increases of the baseline in Ppeak, a more than 10% decreases of the baseline in PETCO2 ,and Ppeak escesses 24 cmH20 as a decision by malposition cutoff values, specifcity and positive predictive rate reached 85.7% and 90% respectively. Conclusion In case of positioning DLT without FOB, the incidence of correctly positioning DLT without carinal hook is improved by combined adjustment of monitoring of Ppeak and PETCO2.
出处
《现代医院》
2014年第1期32-34,共3页
Modern Hospitals
关键词
双腔支气管导管
单肺通气
吸气峰压
呼气末二氧化碳分压
double - lumen endobronchial tube, one lung ventilation, the inspiratory peak airway pressure, end- tidal carbon dioxide
