本文關(guān)鍵詞： 支氣管鏡 右雙腔支氣管導(dǎo)管 右上葉支氣管開(kāi)口 右主支氣管 導(dǎo)管對(duì)位 解剖學(xué) 人　出處：《解剖學(xué)報(bào)》2017年02期 　論文類型：期刊論文

【摘要】：目的探討以纖維支氣管鏡預(yù)觀察右上葉支氣管開(kāi)口解剖方位,對(duì)插右雙腔支氣管導(dǎo)管(R-DLT)對(duì)位的臨床意義。方法選擇插R-DLT成年患者160例,隨機(jī)分為實(shí)驗(yàn)組和對(duì)照組,每組80例。實(shí)驗(yàn)組病例麻醉誘導(dǎo)后預(yù)先行支氣管鏡檢查,主要測(cè)量右主支氣管長(zhǎng)度及右上葉支氣管開(kāi)口在右主支氣管橫切面的方位(以患者正前方12點(diǎn)鐘位置為0度起點(diǎn),按順時(shí)針增大)。兩組按常規(guī)方法將R-DLT插入右側(cè)支氣管,之后以纖維支氣管鏡檢查調(diào)整導(dǎo)管位置。實(shí)驗(yàn)組按之前測(cè)定的支氣管解剖調(diào)整導(dǎo)管深度并作適當(dāng)?shù)男D(zhuǎn),對(duì)照組只調(diào)整導(dǎo)管深度使藍(lán)色的支氣管套囊上緣在隆突之下見(jiàn)到。然后纖維支氣管鏡改從右管腔插入通過(guò)導(dǎo)管的側(cè)孔查看右上葉支氣管開(kāi)口的對(duì)位情況,沒(méi)有進(jìn)一步調(diào)整就能夠看到右上葉支氣管開(kāi)口即為初步對(duì)位成功。最后適當(dāng)微調(diào)導(dǎo)管,直至能看清右上肺尖段、后段及前段3個(gè)開(kāi)口。比較兩組初步對(duì)位成功率以及插管失敗率。結(jié)果實(shí)驗(yàn)組右主支氣管長(zhǎng)度(2.29±0.58)cm,其中短于1cm的有2例,占2.5%;右上葉支氣管開(kāi)口在右主支氣管橫切面方位(94.5±8.3)°,其中有4例(5.0%)明顯偏前或偏后。實(shí)驗(yàn)組右上葉支氣管開(kāi)口初步對(duì)位成功實(shí)驗(yàn)組有77例(96.3%),而對(duì)照組為62例(77.5%),組間差異顯著(P0.05)。兩組各有1例插管失敗,占1.25%,均為右上葉支氣管開(kāi)口與隆突距離較近(1cm)。結(jié)論預(yù)先以纖維支氣管鏡查看右支氣管解剖有助于提高插R-DLT初步對(duì)位的準(zhǔn)確性,并利于插管前發(fā)現(xiàn)右上葉支氣管開(kāi)口變異而選擇合適的導(dǎo)管具有重要意義。
[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 鹵0.58 cm, of which 2 cases were shorter than 1 cm. 2. 5%; The right upper lobe bronchus origination was 94.5 鹵8.3 擄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.
【作者單位】： 溫州醫(yī)科大學(xué)附屬浙江省臺(tái)州醫(yī)院麻醉科;
【分類號(hào)】：R614
【正文快照】： 雙腔支氣管導(dǎo)管(double-lumen endobronchialtube,DLT)的良好對(duì)位對(duì)胸科手術(shù)時(shí)單肺通氣和肺隔離至關(guān)重要。右雙腔支氣管導(dǎo)管(right DLT,R-DLT)較左雙腔支氣管導(dǎo)管(left DLT,L-DLT)對(duì)位困難。因?yàn)橛疑先~支氣管開(kāi)口距氣管隆突很近,僅1.5~2.0cm[1]。R-DLT正確位置的安全范圍小,易

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 孫傳玉;王月蘭;李宗民;;雙腔支氣管導(dǎo)管位置異常原因分析[J];臨床麻醉學(xué)雜志;2013年03期

2 堯銀光;雷李培;吳煒;羊麗麗;王傳光;;改良插管方式在右雙腔支氣管導(dǎo)管的應(yīng)用研究[J];實(shí)用醫(yī)學(xué)雜志;2012年16期

3 許伯林;吳天清;杜禎華;;雙腔支氣管導(dǎo)管定位方法的研究進(jìn)展[J];內(nèi)蒙古中醫(yī)藥;2012年10期

4 周鵬,趙洪偉,劉蔚然,李錦成,高魯渤;右側(cè)Robertshaw導(dǎo)管的臨床應(yīng)用[J];中華麻醉學(xué)雜志;2004年07期

【共引文獻(xiàn)】

相關(guān)期刊論文 前9條

1 朱廣球;王曉霞;曹東航;;預(yù)觀察右上葉支氣管開(kāi)口解剖對(duì)右雙腔支氣管導(dǎo)管對(duì)位的臨床意義[J];解剖學(xué)報(bào);2017年02期

2 劉莉洪;姜小軍;;纖維支氣管軟鏡和B超復(fù)合聽(tīng)診法在雙腔氣管導(dǎo)管定位中的應(yīng)用比較[J];現(xiàn)代實(shí)用醫(yī)學(xué);2017年01期

3 孔德煜;鄧海洪;肖曉山;;雙腔支氣管導(dǎo)管臨床應(yīng)用特點(diǎn)概述[J];現(xiàn)代醫(yī)院;2016年10期

4 陳解元;楊威;王剛;李文成;;右支氣管封堵器在胸科單肺通氣手術(shù)中的應(yīng)用[J];中國(guó)臨床解剖學(xué)雜志;2016年03期

5 劉志永;李榮江;丁翠青;姚長(zhǎng)青;嚴(yán)香菊;王忠義;;不同定位方法在氣胸患者雙腔管定位中的效果比較[J];河北醫(yī)科大學(xué)學(xué)報(bào);2016年04期

6 侯俊德;楊麗萍;魏紅芳;李立英;繆蕓;;雙管喉罩在老年患者開(kāi)胸手術(shù)拔管期的應(yīng)用[J];臨床麻醉學(xué)雜志;2016年01期

7 符紫藝;韓全國(guó);黃建忠;劉永宏;李士翔;黃粱淘;;雙腔支氣管插管單肺通氣用于胸腔鏡肺大皰手術(shù)的麻醉管理[J];吉林醫(yī)學(xué);2014年21期

8 賀偉忠;楊義;高學(xué)超;錢剛;;喉罩過(guò)渡對(duì)雙腔氣管導(dǎo)管拔管期應(yīng)激反應(yīng)的影響[J];臨床麻醉學(xué)雜志;2014年06期

9 盧增停;馬鈞陽(yáng);曾麗蓉;鐘梅英;;以單腔氣管導(dǎo)管插管法行Robertshaw雙腔支氣管插管的可行性分析[J];重慶醫(yī)學(xué);2013年32期

【二級(jí)參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 邢珍;趙永泉;;雙腔支氣管插管309例臨床分析[J];臨床麻醉學(xué)雜志;2009年01期

2 王永順;肖云;王忠惠;趙光瑜;;纖維支氣管鏡評(píng)價(jià)常規(guī)雙腔支氣管導(dǎo)管插管定位的準(zhǔn)確性[J];海南醫(yī)學(xué);2008年11期

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2 朱宜生;;右上葉支氣管發(fā)育畸形1例[J];中國(guó)煤炭工業(yè)醫(yī)學(xué)雜志;2006年06期

3 帥兵;動(dòng)態(tài)增強(qiáng)CT對(duì)評(píng)價(jià)肺門的作用[J];國(guó)外醫(yī)學(xué)(臨床放射學(xué)分冊(cè));1984年06期

4 黃志勇,楊錫耀,鄒小明,陳剛,王武軍;肺原發(fā)惡性纖維組織細(xì)胞瘤3例[J];心肺血管病雜志;1999年02期

5 柴春明;與右主支氣管和右上葉支氣管后壁相鄰的奇靜脈——一種正常CT變異[J];國(guó)外醫(yī)學(xué)(臨床放射學(xué)分冊(cè));1984年01期

6 施俊生;;雙原發(fā)性肺、胃癌一例[J];浙江醫(yī)學(xué);1988年02期

7 ;[J];;年期

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