Park Hee-Pyung, Bahk Jae-Hyon, Oh Yong-Seok, Ham Byung-Moon
Department of Anesthesiology and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
Can J Anaesth. 2002 Oct;49(8):874-6. doi: 10.1007/BF03017424.
To report a case of pulmonary soiling of the dependent and of the non-dependent remaining lung when a Univent tube was used to achieve one-lung ventilation (OLV).
A 61-yr-old, 158-cm, 61-kg woman was scheduled for the resection of a lung cancer in the left lower lobe. An internal diameter 7.0-mm Univent tube was inserted under direct laryngoscopy and positioned via fibreoptic bronchoscopy. Prior to termination of OLV, there was no discharge through the blocker's lumen, aspirated just before deflating the cuff. As soon as the cuff was deflated, however, abundant blood-tinged secretions were aspirated. At the end of the operation, the chest radiograph showed haziness in the right upper lobe and in the remaining left upper lobe. The ineffective removal of secretions through the lumen of the blocker may be one of its main disadvantages. The bronchial blocker is always placed in the non-dependent bronchus for OLV, which may increase the probability of contaminating the dependent lung. Before deflating the blocker, we recommend the steep Trendelenburg position and the presence of a fibreoptic bronchoscope with a suction port at the tracheal carina to prevent overflow of secretions and soiling of the dependent lung.
Whenever a bronchial blocker is used for OLV, we should be cautious about the possibility that secretions accumulated distal to the blocker may contaminate the dependent or the non-dependent remaining lung.
报告一例在使用单腔支气管导管进行单肺通气（OLV）时，非下垂侧及下垂侧余肺发生肺污染的病例。
一名61岁、身高158厘米、体重61千克的女性计划行左下叶肺癌切除术。在直接喉镜下插入内径7.0毫米的单腔支气管导管，并通过纤维支气管镜定位。在OLV结束前，在放气袖带前抽吸时，封堵器管腔内无分泌物排出。然而，一旦袖带放气，就吸出了大量带血的分泌物。手术结束时，胸部X线片显示右上叶和左肺余叶有模糊影。通过封堵器管腔不能有效清除分泌物可能是其主要缺点之一。支气管封堵器在OLV时总是置于非下垂侧支气管，这可能增加污染下垂侧肺的可能性。在封堵器放气前，我们建议采用头低脚高位，并在气管隆突处放置带有吸引端口的纤维支气管镜，以防止分泌物溢出和污染下垂侧肺。
每当使用支气管封堵器进行OLV时，我们应警惕封堵器远端积聚的分泌物可能污染下垂侧或非下垂侧余肺的可能性。
