在胸外科手术前，纤维支气管镜检查是否有必要确认硬质角型支气管内阻塞器的位置？一项随机对照试验。

Is fibre-optic bronchoscopy necessary to confirm the position of rigid-angled endobronchial blockers before thoracic surgery? A randomized controlled trial.

机构信息

Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.

出版信息

Eur J Cardiothorac Surg. 2018 Jan 1;53(1):241-246. doi: 10.1093/ejcts/ezx260.

DOI:10.1093/ejcts/ezx260

PMID:28950380

Abstract

OBJECTIVES

To determine the success rate of blind insertion and the usefulness of fibre-optic bronchoscopy for directing rigid-angled endobronchial blockers (EBs) to the correct side and achieving satisfactory surgical fields.

METHODS

A randomized trial was designed to determine the extent to which the Coopdech Endobronchial Blocker Tube (Daiken Medical Co., Ltd) could successfully be placed through either auscultation (n = 57) or fibre-optic bronchoscopy (n = 55) in patients scheduled for thoracic surgery. The placement time was recorded and quality of the thoracoscopic operation field was determined by the thoracic surgeon. Anaesthesiologists with varying thoracic experience levels were enrolled.

RESULTS

The success rates of insertion through auscultation were 100% (32 of 32) for the right side and 88% (22 of 25) for the left side. Placement through auscultation was faster than that through bronchoscopy (mean 89.6 vs 141.1 s, P = 0.008) in the right-sided procedure but non-significant in the left-sided procedure (mean 138.5 vs 130 s, P = 0.795). Surgical grading of the operation field was not significantly different between both techniques (P = 0.502). Experienced anaesthesiologists took less time to position EBs (mean 91.0 vs 138.0 s, P = 0.015). Surgical grading was comparable between specialists and residents (P = 0.058).

CONCLUSIONS

Once an EB was correctly inserted and confirmed through auscultation, the corresponding surgical satisfaction was comparable to that through bronchoscopy. In the majority of cases, bronchoscopy is unnecessary for correct and efficient EB positioning. However, bronchoscopy is still mandatory in left-sided EB insertion and in patients with deviated tracheobronchial anatomy.

CLINICAL REGISTRATION NUMBER

NCT02133235, registered at ClinicalTrials.gov [https://clinicaltrials.gov/ct2/show/NCT02133235 (8 July 2017, date last accessed)].

摘要

目的

确定盲插的成功率和纤维支气管镜引导硬质角型支气管内阻塞器（EBs）至正确侧别并获得满意手术视野的效果。

方法

采用随机试验设计，评估在计划行胸腔手术的患者中，通过听诊（n=57）或纤维支气管镜（n=55）引导 Coopdech 支气管内阻塞器管（Daiken Medical Co.，Ltd）放置的成功率，并记录放置时间，由胸外科医生确定胸腔镜手术视野的质量。纳入了不同胸腔经验水平的麻醉医师。

结果

听诊引导右侧插入的成功率为 100%（32/32），左侧为 88%（22/25）。右侧程序中听诊引导的放置速度快于纤维支气管镜引导（平均 89.6 秒比 141.1 秒，P=0.008），但左侧程序无显著差异（平均 138.5 秒比 130 秒，P=0.795）。两种技术的手术视野分级无显著差异（P=0.502）。有经验的麻醉医师放置 EBs 的时间更短（平均 91.0 秒比 138.0 秒，P=0.015）。专家和住院医师的手术分级相当（P=0.058）。