| Objective:To investigate the fiberoptic bronchoscope (FOB) positioning method in open heart surgery one-lung ventilation (OLV) application, the validity, reliability and security.Methods 200 patients were randomly selected to be line of one-lung ventilation (OLV) for thoracotomy patients, ASA gradeⅡ-Ⅲ-class, male 112 cases,88 cases of women, age:18-75 years, mean (53±14) years old 146-185cm tall and weight 43-88kg, without the appearance of the airway physical examination abnormalities. All patients with preoperative cardiac and pulmonary function tests were normal or within the scope of the compensation, lung ventilation was more than 90% SpO2 finger. Randomly divided into:auscultation (T) group:100 cases, of which the left double-lumen endoendobronchial tube (left double-lumen endoendobronchial tube, L-DLT) intubation in 56 cases, the right double-lumen endoendobronchial tube (right double-lumen endoendobronchial tube, R-DLT) intubation in 44 cases. FOB (F) group:100 cases, of which the left double-lumen endoendobronchial tube (L-DLT) intubation in 52 cases, the right double-lumen endoendobronchial tube (R-DLT) intubation 48. All patients after adequate preoperative preparation of thoracic surgery, they were received into the operating room. And then by the intravenous injection of midazolam 0.05-0.1mg/kg, fentanyl 3-4μg/kg, propofol 1-2mg/kg, rocuronium 0.6mg/kg for anesthesia induction, after induction of the traditional method [10] into the DLT (now usually Robertshaw double lumen endobronchial tube) and record the depth of catheter insertion, the general insertion depth of 29-31cm [11]. After catheterization, respectively, two groups of patients on the pipe end position. Auscultation Group:auscultation [12] accurate positioning criteria: endotracheal balloon inflated, auscultation, adjust the position of double-lumen tubes can be heard with satisfaction the lungs caused by breathing sounds, and endobronchial balloon inflated, auscultation, adjust the position of double-lumen tube To the satisfaction of lung breath sounds can be heard, and then bilateral lung were performed one-lung ventilation, auscultation, adjust the position of double-lumen tube side of the lungs caused by ventilation can hear breath sounds satisfactory, rather than non-ventilated lung was breathing sound. Fault location criteria:①,lung ventilation, only one side of the lung could hear breath sounds (too deep to the side of the catheter caused the main bronchus).②, lungs were single-lung ventilation, the lungs can also hear a clear breath sounds (caused by too shallow catheterization)③, one-lung ventilation, the contralateral upper lobe not hear breath sounds (endobronchial catheter obstruction or endobronchial tube cuff upper lobe bronchus causing mouth).④, lungs were single-lung pass, the ipsilateral lung is weak or can not hear breath sounds breath sounds breath sounds clear and the contralateral lung (endobronchial tube cuff partial or complete obstruction of the contralateral main bronchus caused by mouth). FOB Group: FOB directly under the double-lumen endobronchial tube positioning, targeting mostly the standard reference PD Slingerm [13] method:the best place to:1, L-DLT FOB into the right side of the first tube, the openings can be seen in the tracheal lumen catheter, carina, right endobronchial openings, has been inflated endobronchial cuff (blue cuff) on the edge in the subcarinal; FOB tube inserted into the left shows the upper left, lower lobe bronchus mouth.2, R-DLT first FOB into the left tube, the openings can be seen in the tracheal lumen catheter, carina, left main bronchus opening, has been inflated endobronchial cuff (blue cuff) on the edge in the subcarinal;FOB insert right side of the tube, the catheter port can be seen in the right lung, lower lobe bronchus opening side of the hole can be seen right upper lobe bronchus opening. Dislocation:(1), the general dislocation of catheter movement is greater than the correct position than 0.5cm. (2), severe dislocation to:①catheter inserted into the opposite main bronchus.②full catheter deep into the bronchus.③catheter into the bronchus is not too shallow. Monitored and recorded: 1, the two groups after the change in the position peak airway pressure (Paw) is greater than the number of cases 30cmH20 and two one-lung ventilation after 30min,60minSpO2 value of less than 90% of the number of cases.2, recording two groups were intubated in the way different types of single-lung ventilation in different position the number of patients satisfaction, satisfaction rate and thoracic surgery are not satisfied with single lung was found to be FOB in the number of cases adjust the positioning.3, the two groups in different positions are not satisfied with one-lung ventilation, FOB check catheter too deep or too shallow the number of cases.4, recorded two postoperative complications, discovery and disposal aspects.Results auscultatory location in one-lung ventilation in the low success rate of one-time positioning, different positions, different tube types (L-DLT, R-DLT) low satisfaction with one-lung ventilation, postoperative complications are more, and can not used to find the causes and complications of its disposal. The FOB location method in single-lung ventilation time targeting a. high success rate, different positions, different tube types (L-DLT, R-DLT) satisfaction with one lung ventilation rate, fewer postoperative complications, in addition, can also be used to find the causes and complications of its treatment.Conclusion 1, the use of one-lung ventilation DLT, DLT positioning on auscultation alone, there is a certain subjectivity and blindness, its accuracy, reliability, safety is not high.2, FOB location for DLT in the use of one-lung ventilation, FOB positioning of DLT intuitive, is an accurate, reliable and secure method of DLT positioning, it should be generally routine used in the one-lung ventilation of the chest, heart surgery and become a "gold standard" in one-lung ventilation for DLT positioning... |
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