Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
J Cardiothorac Vasc Anesth. 2020 Nov;34(11):3068-3072. doi: 10.1053/j.jvca.2020.06.073. Epub 2020 Jun 26.
To investigate the incidence of tracheal bronchus (TB) and explore its implication for lung isolation.
Retrospective cohort study.
Academic, tertiary care hospital.
The study comprised 7,102 thoracic patients with- one lung ventilation.
No intervention.
Two independent anesthesiologists reviewed the computed tomography images to identify the presence of a TB, and their results were confirmed by a radiologist. The clinical data of patients with a TB were obtained from the electronic medical record. Data regarding the device used to provide lung isolation, preoperative oxygen saturation (SpO), and intraoperative SpO during one- lung ventilation were obtained from the electronic anesthesia record. The incidence of TB was 1.08% (77 of 7,102). The TB arose from the right side of the trachea in all 77 patients, including 70 type Ⅲ TBs and 7 type Ⅱ TBs. Left- and right-sided double-lumen tubes (DLTs) were used in 54 and 23 patients, respectively. For patients with a left-sided DLT, the median SpO and incidence of hypoxemia (SpO <90%) were 97% and 6 of 54 (11.1%), respectively. For patients with a right DLT, the median SpO and incidence of hypoxemia were 95% and 7 of 20 (35.0%), respectively. There were significant differences in the mean SpO and the incidence of hypoxemia between patients intubated with left- and right-sided DLTs (p = 0.014 and p = 0.016, respectively).
Preoperative diagnosis of TB is important when lung isolation is needed. The left-sided DLT can be used for most patients with a TB.
探讨气管支气管（TB）的发生率及其对肺隔离的意义。
回顾性队列研究。
学术性三级护理医院。
本研究纳入了 7102 例接受单肺通气的胸科患者。
无干预措施。
两名独立的麻醉师对 CT 图像进行评估以确定 TB 的存在，其结果由放射科医生进行确认。TB 患者的临床数据从电子病历中获得。从电子麻醉记录中获得与提供肺隔离的设备、术前血氧饱和度（SpO）以及单肺通气期间的术中 SpO 相关的数据。TB 的发生率为 1.08%（77/7102）。77 例患者的 TB 均起源于气管的右侧，包括 70 例 Ⅲ型 TB 和 7 例 Ⅱ型 TB。54 例患者使用左侧双腔管（DLT），23 例患者使用右侧 DLT。对于左侧 DLT 的患者，SpO 的中位数和低氧血症（SpO<90%）的发生率分别为 97%和 6/54（11.1%）。对于右侧 DLT 的患者，SpO 的中位数和低氧血症的发生率分别为 95%和 7/20（35.0%）。左侧和右侧 DLT 患者的平均 SpO 和低氧血症的发生率存在显著差异（p=0.014 和 p=0.016）。
当需要肺隔离时，术前诊断 TB 很重要。左侧 DLT 可用于大多数 TB 患者。
