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即时超声检查与听诊在确定双腔管位置方面的比较

Point-of-care ultrasound versus auscultation in determining the position of double-lumen tube.

作者信息

Hu Wei-Cai, Xu Lei, Zhang Quan, Wei Li, Zhang Wei

机构信息

Department of Thoracic Surgery Department of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou, China.

出版信息

Medicine (Baltimore). 2018 Mar;97(13):e9311. doi: 10.1097/MD.0000000000009311.

Abstract

This study was designed to assess the accuracy of point-of-care ultrasound in determining the position of double-lumen tubes (DLTs).A total of 103 patients who required DLT intubation were enrolled into the study. After DLTs were tracheal intubated in the supine position, an auscultation researcher and ultrasound researcher were sequentially invited in the operating room to conduct their evaluation of the DLT. After the end of their evaluation, fiberscope researchers (FRs) were invited in the operating room to evaluate the position of DLT using a fiberscope. After the patients were changed to the lateral position, the same evaluation process was repeated. These 3 researchers were blind to each other when they made their conclusions. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were obtained by statistical analysis.When left DLTs (LDLTs) were used, the accuracy of ultrasound (84.2% [72.1%, 92.5%]) was higher than the accuracy of auscultation (59.7% [45.8%, 72.4%]) (P < .01). When right DLTs (RDLTs) were used, the accuracy of ultrasound (89.1% [76.4%, 96.4%]) was higher than the accuracy of auscultation (67.4% [52.0%, 80.5%]) (P < .01). When LDLTs were used in the lateral position, the accuracy of ultrasound (75.4% [62.2%, 85.9%]) was higher than the accuracy of auscultation (54.4% [40.7%, 67.6%]) (P < .05). When RDLT were used, the accuracy of ultrasound (73.9% [58.9%, 85.7%]) was higher than the accuracy of auscultation (47.8% [32.9%, 63.1%]) (P < .05).Assessment via point-of-care ultrasound is superior to auscultation in determining the position of DLTs.

摘要

本研究旨在评估床旁超声在确定双腔气管导管(DLT)位置方面的准确性。共有103例需要进行DLT插管的患者纳入本研究。在患者仰卧位进行DLT气管插管后,依次邀请一名听诊研究人员和一名超声研究人员进入手术室对DLT进行评估。在他们评估结束后,邀请纤维支气管镜研究人员(FRs)进入手术室使用纤维支气管镜评估DLT的位置。患者改为侧卧位后,重复相同的评估过程。这3名研究人员在得出结论时相互不知情。通过统计分析获得敏感性、特异性、阳性预测值、阴性预测值和准确性。使用左双腔气管导管(LDLT)时,超声的准确性(84.2%[72.1%,92.5%])高于听诊的准确性(59.7%[45.8%,72.4%])(P<0.01)。使用右双腔气管导管(RDLT)时,超声的准确性(89.1%[76.4%,96.4%])高于听诊的准确性(67.4%[52.0%,80.5%])(P<0.01)。当在侧卧位使用LDLT时,超声的准确性(75.4%[62.2%,85.9%])高于听诊的准确性(54.4%[40.7%,67.6%])(P<0.05)。当使用RDLT时,超声的准确性(73.9%[58.9%,85.7%])高于听诊的准确性(47.8%[32.9%,63.1%])(P<0.05)。通过床旁超声评估在确定DLT位置方面优于听诊。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5742/5895420/084a74baf0d5/medi-97-e9311-g001.jpg

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