患者男，43岁，胸闷，咳嗽伴低热一月余，胸片提示左侧液气胸，左肺压缩80%。临床诊断左侧液气胸，结核性胸膜炎。拟行胸部探查，术前访视右肺呼吸清晰，左肺呼吸消失，已行胸腔闭式引流。
术前用药鲁米那0.1，阿托品0.5mg肌注。麻醉前R20次/分钟，SpO2 94%，Bp9.5/1.7kpa，P102bpm。静脉快速诱导插入R37#导管，双侧套囊充气后，两肺分别通气检查时，发现左肺压不进气且无呼吸音，右肺通气正常，当时判断为导管扭曲。排空套囊后在喉镜显露下缓慢退出导管未见扭曲。重新插入R39#导管，双侧套囊充气，两肺分别通气检查，结果同前。故排除双腔导管引起的故障。分析原因为左主支气管堵塞或左肺毁损。为避免双腔管内径小引起的通气阻力增大，决定改用9.0#单腔气管导管直接插入右主支气管行单肺通气。EtCO2及SpO2正常范围.术中探查发现左肺全部毁损，切除左侧全肺，检查左支气管残端直径约1.5cm，无狭窄及堵塞。手术顺利，术毕神清，自主呼吸恢复正常，SpO2 98%拔管送返。台下将切除的左肺接导管加压通气肺亦无法膨胀。次日访视无全麻并发症，术后14天痊愈出院。术后诊断结核性毁损肺。
（深圳市龙岗区第二人民医院麻醉科）
讨论：需要健侧和患侧隔离的胸科手术应以双腔管为首选。
在以下情况时，亦可用单腔管直接插入健侧行单肺通气：
①患肺完全无通气功能。
②插入双腔管有困难。
③允许插入的双腔管内径过细（如年龄小、体格过小的病人）影响通气。
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The attached is only for the reference on hard ventilation from double-lumen intubation
The presence of an ETT in the trachea produces
reflex bronchoconstriction.11 Bronchospasm may be
especially severe in the lightly anaesthetized patient with
reactive airways. Bronchospasm may be blunted by the
prior administration of anticholinergics, steroids, inhaled
b2-agonists, lignocaine (topical, nerve block, intravenous),
and narcotics. After intubation, deepening anaesthesia with
intravenous or inhaled agents and the administration of
inhaled or intravenous b-agonists are helpful. It is important
to ensure that the audible wheezing is not due to mechanical
obstruction of the tube or other causes, such as tension
pneumothorax, or heart failure.
书上竟然说可以。
