Alliaume B, Coddens J, Deloof T
Department of Anaesthesia and Intensive Care, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
Can J Anaesth. 1992 Sep;39(7):687-90. doi: 10.1007/BF03008231.
Auscultation is a well-established technique to confirm the position of double-lumen endobronchial tubes (DLTs). However, some authors have recommended that fibreoptic bronchoscopy (FOB) is also indicated. The aims of this study were to determine first if bronchoscopy after blind placement of DLTs improved positioning; and second if preoperative bronchoscopy could detect difficult intubation. Twenty-four patients undergoing aortic or lung surgery were studied. After intubation with a single-lumen tube, an initial FOB was performed by an independent observer to check the airway anatomy. Then, the single-lumen tube was replaced by a DLT using a classical "blind" intubation method. Subsequent FOB was performed first by the independent observer to record the DLT position and next by the investigators for improvement or correction of their positioning under visual control. Fibreoptic bronchoscopy after blind placement of DLTs resulted in repositioning 78% left-sided DLTs and 83% right-sided DLTs. Preoperative bronchoscopy did not always detect an airway abnormality which might lead to difficult positioning of the DLTs. In conclusion, auscultation is an unreliable method of confirming the position of DLTs and should be followed by fibreoptic bronchoscopy.
听诊是确定双腔支气管导管（DLT）位置的一项成熟技术。然而，一些作者建议也应使用纤维支气管镜检查（FOB）。本研究的目的，一是确定DLT盲目置入后进行支气管镜检查是否能改善其定位；二是术前支气管镜检查能否检测出困难插管情况。对24例接受主动脉或肺部手术的患者进行了研究。在使用单腔气管导管插管后，由一名独立观察者进行初始FOB以检查气道解剖结构。然后，使用经典的“盲目”插管方法将单腔气管导管更换为DLT。随后，先由独立观察者进行FOB以记录DLT位置，接着由研究人员在可视控制下对其位置进行调整或纠正。DLT盲目置入后进行纤维支气管镜检查，结果显示78%的左侧DLT和83%的右侧DLT需要重新定位。术前支气管镜检查并不总能检测出可能导致DLT定位困难的气道异常情况。总之，听诊是确认DLT位置的不可靠方法，之后应进行纤维支气管镜检查。
