Department of Anesthesiology, Ebara Hospital, 4-5-10 Higashiyukigaya, Ota-ku, Tokyo, Japan.
Department of Radiology, Ebara Hospital, Tokyo, Japan.
J Anesth. 2018 Aug;32(4):649-651. doi: 10.1007/s00540-018-2521-9. Epub 2018 Jun 20.
This study was designed to examine deviation of the bronchus by postural change from supine to lateral position during spontaneous respiration. Fifteen healthy volunteers [13 men and 2 women, mean age: 34 years (range 26-42)] participated. Chest radiograms (anterior-posterior) were acquired in the order of supine, left lateral, and right lateral position. The bilateral bronchus angles and secondary carina angles were measured in the acquired images, and the angles were compared between the supine and lateral positions to evaluate deviation of the bronchus in the lateral position. The left secondary carina angle in the supine position was 61.3° ± 4.0° and it significantly increased to 65.5° ± 6.0° in the left lateral position (P = 0.001), but no significant difference was noted in the left bronchus angle between the supine and left lateral positions (P = 0.158). The curvature of left main bronchus, which we defined more than 5° increase in secondary carina angle, was observed in a half of the male participants during left lateral position. We should be aware of these anatomical changes due to the surgical posture as a possible cause for ventilation failure during one-lung ventilation.
本研究旨在观察自主呼吸时仰卧位向侧卧位转变时支气管的偏移。15 名健康志愿者[13 名男性，2 名女性，平均年龄 34 岁（26-42 岁）]参与了本研究。胸部射线照片（前后位）按仰卧位、左侧卧位和右侧卧位的顺序获取。在获取的图像中测量双侧支气管角和二级隆突角，并比较仰卧位和侧卧位的角度，以评估侧卧位时支气管的偏移。仰卧位时左侧二级隆突角为 61.3°±4.0°，左侧卧位时显著增加至 65.5°±6.0°（P=0.001），但仰卧位和左侧卧位时左侧支气管角无显著差异（P=0.158）。在左侧卧位时，我们定义的左侧主支气管曲率（即二级隆突角增加超过 5°）在一半的男性参与者中可见。由于手术体位，我们应注意这些解剖结构的变化，因为这可能是单肺通气期间通气失败的原因。
