一项评估环状软骨移位手法对双腔管和单腔支气管阻塞器盲插成功率影响的随机试验。

A randomized trial to assess the effect of cricoid displacing maneuver on the success rate of blind placement of double-lumen tube and Univent bronchial blocker.

作者信息

Xu Zhao, Yu Hong, Luo Yuting, Ye Yuancai, Zhou Cheng, Liang Peng

机构信息

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.

West China School of Medicine, Sichuan University, Chengdu, China.

出版信息

Ann Palliat Med. 2021 Feb;10(2):1976-1984. doi: 10.21037/apm-20-2065. Epub 2021 Jan 12.

DOI:10.21037/apm-20-2065

PMID:33440969

Abstract

BACKGROUND

Double lumen tube (DLT) and Univent are two commonly used lung isolation devices that often require bronchoscopy assistance. In order to facilitate blind placement for situations where bronchoscopy was unavailable, the cricoid displacing maneuver (CDM) was adopted. This study was designed to explore whether the CDM could improve the successful blind placement rate in left lung isolation esophageal surgeries.

METHODS

120 ASA 1-3 patients who received left lung isolation esophageal surgeries from October 2014 to February 2016 and October 2018 to January 2020 were enrolled in this single-centered prospective assessorblinded randomized controlled trial. After anesthesia induction, patients were intubated either with DLT or Univent by applying the CDM, and the position of devices was checked by bronchoscopy. After turning into the right decubitus position, the devices were pulled back to the trachea, and placement was conducted once again. Successful placement rate for the first attempt, time needed for initial placement, malposition and reposition times by bronchoscopy during surgery, bronchus injury score, rank of lung isolation and postoperative anesthesia-related complications were recorded.

RESULTS

At supine position, the successful placement rates for the first attempt of DLT-CDM, DLTcontrol, Univent-CDM and Univent-Control were 100%, 76.7%, 96.7% and 66.7% respectively (DLT: P=0.016; Univent: P=0.003) while at right decubitus position were 86.7%, 66.7%, 93.3% and 66.7% (DLT: P=0.067; Univent: P=0.010). There was no significant difference in the time needed for successful intubation and no severe complications.

CONCLUSIONS

The current study provided evidence that the CDM is an effective and safe blind endobronchial placement technique for left DLT and Univent. We suggest that CDM could be applied to the endobronchial placement of left DLT and Univent.

摘要

背景

双腔支气管导管（DLT）和单腔支气管阻塞导管（Univent）是两种常用的肺隔离装置，通常需要支气管镜辅助。为便于在无法进行支气管镜检查的情况下盲目放置，采用了环状软骨移位操作（CDM）。本研究旨在探讨CDM是否能提高左肺隔离食管手术中盲目放置的成功率。

方法

本单中心前瞻性评估者盲法随机对照试验纳入了2014年10月至2016年2月以及2018年10月至2020年1月期间接受左肺隔离食管手术的120例美国麻醉医师协会（ASA）1-3级患者。麻醉诱导后，通过应用CDM使用DLT或Univent对患者进行插管，并通过支气管镜检查装置位置。转为右侧卧位后，将装置拉回气管并再次进行放置。记录首次尝试的成功放置率、初始放置所需时间、手术期间支气管镜检查发现的位置不当及重新放置次数、支气管损伤评分、肺隔离等级和术后麻醉相关并发症。

结果

在仰卧位时，DLT-CDM、DLT对照组、Univent-CDM和Univent对照组首次尝试的成功放置率分别为100%、76.7%、96.7%和66.7%（DLT：P = 0.016；Univent：P = 0.003），而在右侧卧位时分别为86.7%、66.7%、93.3%和66.7%（DLT：P = 0.067；Univent：P = 0.010）。成功插管所需时间无显著差异，且无严重并发症。