鑑別氣管內插管和食道內插管的新方法－－“氣管插管鑑定囊＂檢測術

The Tracheal Detecting-bulb: A New Device to Distinguish Tracheal from Esophageal Intubation

背景：氣管插管鑑定囊檢測術是診斷氣管導管是否位於氣管內的新技術。呼出氣二氧化碳濃度檢測是該檢測的公認標準。本研究之目的是比較上述兩種方法的檢測結果是否一致。方法：四百名患者隨機分為三組，第一組200名患者，氣管插管術後依次用“氣管插管鑑定囊”和呼出氣二氧化碳濃度法做檢測；二組病人100例，先做食道內插管，用上述兩種方法檢測後將導管拔除，雙肺通氣後做氣管內插管，重新檢測；第三組病人100例，採用雙盲隨機法，氣管導管或被插入食道(n = 42)，或被插入氣管(n = 58)，檢測方法同上。結果：第一組173名患者在氣管插管鑒定囊檢測術中乳膠套囊出現了節律性的脹縮現象，並檢測出呼出氣二氧化碳濃度，證實氣管導管插入氣管；另27例患者的乳膠套囊沒有出現節律性的脹縮，也沒有檢測出呼出氣二氧化碳濃度曲線，表明氣管導管位於食道。第二組中無論是氣管內插管抑或是食道內插管，氣管插管鑒定囊檢測和呼出氣二氧化碳濃度檢測的結果均呈一致。在第三組病例中，兩種檢測方法的結果也完全相符。三組全部400例患者的觀察中，上述兩種檢測方法的結果總是一致。“氣管插管鑑定囊”的敏感性、特異性和預期值均為100％。結論：氣管插管鑑定囊檢測術是一種有價值的檢測技術，它能正確判定氣管導管是在氣管內還是在食道中，其檢測結果與呼出氣二氧化碳濃度檢測法一致。

Background: The tracheal detecting-bulb (TDB)* is a diagnostic tool for confirmation of tracheal intubation. Capnography is also accepted as a standard way for such confirmation. The purpose of this investigation was to determine whether the results by TDB agreed with those by capnography. Methods: Four hundred patients were allocated to three separate studies. In 200 consecutive patients of study 1, tracheal intubation was first confirmed with the TDB followed by capnography. In study 2,100 patients had the esophagus intentionally intubated, and confirmation was performed likewise as in study 1. The tube was then removed, the trachea was intubated, and confirmation tests followed. Study 3 involved 100 patients and was carried out in a double-blind, randomized manner. The tube was intentionally inserted into either the esophagus (n = 42) or trachea (n = 58), and confirmation tests immediately followed. Results: In study 1, the rhythmic expansion-contraction of TDB was evident in 173 patients, and always agreed with capnographic reading; In 27 instances, the latex bulb of TDB remained collapsed or was scantily filled without the turning-up of capnographic reading as counterchecked, indicating esophageal intubation. In study 2, regardless of esophageal or tracheal intubation, agreement between TDB and capnogram was 100%. In study 3, the agreement between the two detecting instruments was 100% too. In the 400 patients studied, the results from the TDB were in complete accord with those of capnogram. The sensitivity, specificity, and predictive value of the TDB in all of these studies were 100%. Conclusions: The TDB is a valuable diagnostic technique for confirming tracheal intubation as it could correctly detect esophageal or tracheal intubation of the tracheal tube in all our 400 patients. The results of using TDB agree with the results of using capnography.