| Double-lumen bronchial tube?DLT? is one of the thoracic surgery, the most commonly used means of bronchopulmonary sequestration, has a history of more than half a century. Lung isolation have relatively indication and absolute indication, relative indications means in order to facilitate the operation of the performer makes lateral thoracic collapsed lung to provide a good operation field;Absolute indications means on one side of the lungs or the chest there is pollution, need to prevent the contralateral lung being polluted.The DLT catheter perfect applies to both.More than half a century, people for the model selection and positioning of double cavity bronchial tube has more mature method, maximum limit reduces the incidence of complications, but in view of the particularity of around adults bronchial anatomy, the vast majority of people in the industry are discussing how to better use of the left DLT and avoid the right DLT as far as possible. Investigate its reason,is that right main bronchail from the main windpipe is shown after a trend in the direction of short straight down in the right lung branch,but after a first or upper lobe of right lung tip distance is very close to the location from the trachea,an average of about 2.4 cm,and the left side of the branch from the primary tracheal bronchus direction is tending to level down from the branches in the left lung,left bronchus first open position is the location far from the distance,in general can be up to 4.06.0 cm.So,insert the right side of the clinical anesthesia endotracheal intubation,sometimes there may be too deep intubation more than the upper lobe bronchus,bronchial intubation hindered the upper lobe bronchus lung ventilation,such as hold on to less unilateral lung ventilation for upper lobectomy of lung ventilation, patients may appear insufficient oxygenation,causing inconvenience to the performer,bring risk to the patient and anesthesia.But sometimes in the clinical work right DLT is inevitable:for example,the left lung especially wet lung for the surgery;overweight right arm reclining patients use the left DLT exist a right pulmonary ventilation airway pressure too high or even right main bronchus was completely closed;besides the right DLT in certain operation will bring clean subcarinal lymph node operating inconvenience and so were rejected by the surgeon.So this article is to explore for thoracic surgery patients who need right DLT who can use of computed tomography?CT? to predict the length of the right main bronchus,whether can satisfy the insert right after the DLT maintain good isolation of the lungs. Part 1 Reading CT slice of anticipation patients right main branch lengthlevel and airway coronal reconstruction of right main measu-rements correlation studiesObjective: To explore whether there is a correlation between reading CT slice of anticipation patients right main branch length grade and right main branch length mearsured by airway three-dimensional reconstruction measurement presence.Methods: Selection on the line of 30 patients with CT examination, airway 3 D reconstruction is used to measure the promontory to upper lobe bronchus wall distance as the right main bronchus length D;Read the sagittal CT slice of anticipation patients right mainstem length grade D.Our CT interval with a thick layer of 5 mm, according to several different right main branch length for the patient with a thick layer of classification: grade D '< ?5 mm, grade ?5 mm ? D' < 10 mm, ?grade 10 mm ?D'< 15 mm, ?grade15 ?D' < 20 mm, level 20 mm ??D'.To explore whether there was a linear related relationship between D and D'if any, calculate the correlation coefficient.Results:The Spearman rank correlation analysis.Results show that the measured values D and 3 D reconstruction CT slice measurement sagittal position right mainstem length grade D correlation coefficient is 0.991, P= 0.000, the difference was statistically significant.Conclusion:Reading sagittal CT slice of anticipation patients right mainstem length level in the Operating room and airway three-dimensional reconstruction measurement is a clear correlation between the length of the right main bronchus, clinical work for the sake of convenient and fast, can the former instead of the latter. Part 2 Reading CT slice of anticipation right mainstem length chest pati-ents right of different levels DLT one-lung ventilation effect com-pareisonObjective: To explore whether there is a diffirence between under ?level?including ?level? and ?above?contain ?? right of DLT one-lung ventilation effect measured by reading CT slice of anticipation right main bronchial length level.Methods: Selection and under our line of esophagus cancer or cardia cancer patients 80 cases, reading CT slice of anticipation right main bronchial length level under ?level?including ?level? for A group of 40 cases and ? above?contain level? for 40 cases in group B.Comparison of the general ?conditions, two groups of patients with intraoperative one-lung ventilation oxygen saturation, the airway peak pressure, collapsed lung classification, adjust the tube position cases and postoperative hoarseness, sore throat and other 24 h airway complications related to presence of differences.Results: 1 Two groups of patients with general data in gender, age, height, weight, etc. In general, there was no statistically significant difference comparing?P>0.05?.2 Two groups of patients with pulse oxygen saturation using the rank correlation nonparametric test, P>0.05, no statistically significant differences between the two groups.3. Two groups of patients were compared using t test, P=0.005,P<0.05, there is significant difference between the two groups, patients in group A of single lung ventilation airway peak pressure is higher than group B in half an hour.4. Compares the rank transformation between the two groups of patients with nonparametric test, because it is A level of data, so using speramen rank correlation, the results of P = 0.002, P<0.05, the statistical differences between the two groups, group A collapsed lung patients can be thought of graded higher than that of group B, group A intraoperative collapsed lung effect is poor.5. Between the two groups of patients use fiber lens to adjust the number of count data, using chi-square test, as A result, P<0.05, differences exist between the two groups statistically significant, means that patients in group A need to adjust the number of cases using bronchoscopy mirror again more than group B, group A double cavity bronchial tube intraoperative position stability is worse than group B.6. Two groups of 24 h postoperatively in patients with a sore throat, hoarseness windpipe related complications, the number of cases for categorical data, using chi-square test, as A result, P<0.05, differences exist between the two groups statistically significant, A group of patients with postoperative 24 h can be thought of a sore throat and hoarseness windpipe related complications, the number of cases is more than group B.Conclusion:Operating room reading sagittal CT slice of anticipation patients a right main bronchial length level ?? 0 mm?D<15 mm patients than the grade is ? ?patients?15mm ?D? or less intraoperative high airway pressure, collapsed lung effect is poor, high incidence of airway complications associated, intraoperative pipe end shift should readjust rate is high. |
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