Panacek E A, Albertson T E, Rutherford W F, Fisher C J, Foulke G E
Case Western Reserve University, Department of Medicine, Cleveland 44106.
Chest. 1989 Apr;95(4):885-7. doi: 10.1378/chest.95.4.885.
Suctioning of secretions from the left endobronchial tree is frequently necessary but often difficult in intubated patients. We examined the effectiveness of a catheter designed expressly for this purpose. Special curved tip (Bronchitrac-L) suction catheters were fitted with thin, radiopaque tubing to facilitate x-ray visualization. Eight-one attempts at left endobronchial placement were made on 74 stable adult intensive care unit patients. The suction catheter was inserted into the oral endotracheal tube or tracheostomy tube just prior to an x-ray filming of the chest. In 15 of 66 patients, the tip of the oral endotracheal tube was too distal (less than 2 cm above the carina) to allow proper functioning of the catheter. Patients with a properly positioned oral endotracheal tube were analyzed separately and showed 56 percent of the catheters went to the left bronchus. When the head was turned to the left prior to placement, successful left bronchus placement occurred in 65 percent. When the catheter was placed through a tracheostomy tube, 100 percent went into the left bronchus (n = 15). There were no catheter-induced complications in this study. The curved tip catheter is an effective means of suctioning the left bronchial tree in patients with tracheostomy tubes. Its reliability in patients with oral endotracheal tubes is reduced but more effective than current methods.
对于插管患者，经常需要从左主支气管树吸痰，但往往很困难。我们研究了一种专门为此设计的导管的有效性。特殊弯曲尖端（Bronchitrac-L）吸引导管配有细的不透射线的管道，以利于X线显影。对74例稳定的成人重症监护病房患者进行了81次左主支气管放置尝试。在胸部X线拍摄前，将吸引导管插入口腔气管内导管或气管造口管。在66例患者中的15例中，口腔气管内导管尖端位置过远（隆突上方小于2 cm），导致导管无法正常工作。对口腔气管内导管位置合适的患者进行单独分析，结果显示56%的导管进入左支气管。放置前将头转向左侧时，65%的患者成功将导管置入左支气管。当通过气管造口管放置导管时，100%的导管进入左支气管（n = 15）。本研究中未出现导管引起的并发症。弯曲尖端导管是吸除气管造口管患者左支气管树分泌物的有效方法。其在口腔气管内导管患者中的可靠性降低，但比现有方法更有效。
