纤维支气管镜在开胸术中的应用（河北省唐山市胜利路65号唐山市人民医院河北唐山063000）【摘要】目的: 应用纤维支气管镜评价常规双腔支气管导管插管定位的准确性。
方法: 60 例择期行开胸手术, 术中需要单肺通气的胸部肿瘤患者, asa 分级i～ii 级。
麻醉诱导后由一位麻醉医师选择并插入一次性pvcrobertshaw双腔支气管导管, 先用听诊法确定导管的位置, 再由另一位麻醉医师用纤维支气管镜（fiberoptic bronchoscope, fob）确定和调整导管的位置, 记录结果。
当病人由平卧位改为侧卧位时, 再进行听诊和fob 检查, 记录结果。
当导管位置偏离正确位置0. 5cm 以上时认为是导管错位。
同时记录单肺通气时的气道峰压（paw）、血氧饱和度（spo2 ）。
结果: 在平卧位和侧卧位时, fob检查时有71.3%和45. 0%的导管位置需要重新定位。
平卧位导管错位时, 插入过深和插入过浅发生率相似, 侧卧位以插入过浅为主。
右侧双腔管较左侧双腔管更易出现错位。
结论: 使用robertshaw 导管行肺隔离时, 在病人平卧位和侧卧位时用纤维支气管镜对导管定位更为准确、可靠。
【关键词】双腔支气管导管;纤维支气管镜;定位the role of fiberoptic bronchoscope in the positioningof double- lumen endobronchial tubezou guohonggan jianhui【abstract】objective： to evaluate the accuracy of positionning double-lumen tube （dlt） intubation with fibreoptic bronchoscopy. methods: one hundred and twenty asa i～ii patients who underwent thoracic operation and required one lung ventilation （olv ）were studied. after anesthesia induction, a selected portex robertshaw dlt was inserted by one anesthetist. bronchoscopy was performed by another anesthetist after intubation and auscultative verification of correct placement and after patient positioning for thoracotomy. a dlt was considered malplacement when its deviation >0.5cm. then the results were recorded. meanwhile paw and spo2 during olv were recorded.results: after blind intubation and patient positioning, dlt was found to be displaced in 71.3% and 45.0% by bronchoscopy. distal malposition was similar with proximal malposition after intubation. but after positioning, proximal malposition occurred more frequently than distal malposition. right- sided dlt was significantly more likely to be displaced than left- sided dlt.conclus ion:the use of fob as a diagnostic tool in positioning the robertshaw pvc- dlt both after blind intubation and after patient positioning is reliable andnecessary.【key words】key words robertshaw dlt;fob; positioning 【中图分类号】r655 【文献标识码】a【文章编号】1008-6455（2011）06-0160-02目前, 单肺通气是通过双腔支气管导管（double –lumen tube，dlt）插管实现，dlt准确定位才能保证两肺的充分隔离和单肺通气的质量。
