Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
Asian J Anesthesiol. 2021 Mar 1;59(1):22-34. doi: 10.6859/aja.202103_59(1).0003. Epub 2021 Jan 21.
The choice between a double-lumen tube (DLT) and a bronchial blocker (BB) for lung isolation remains controversial. The aim of this study was to determine if the features of these lung isolation devices affect postoperative pulmonary outcomes.
We retrospectively identified claims by patients who underwent surgery under lung isolation in 2000-2012 in the Taiwan National Health Insurance Research Database. After matching for age, sex, and year of surgery, 1,898 patients were enrolled in a BB group and 5,694 in a DLT group. The risks of readmission in the first postoperative year with pulmonary complications, in-hospital death, and one-year mortality were estimated using conditional logistic regression analysis.
Patients in the BB group had higher risks of readmission with pulmonary infection (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI], 1.22-1.74) or respiratory failure (aOR, 1.38; 95% CI, 1.09-1.76) in the first postoperative year as well as in-hospital death (aOR, 2.03; 95% CI, 1.40-2.94) and one-year mortality (aOR, 1.94; 95% CI, 1.60-2.35) than those in the DLT group after adjustment for the types of the surgeries, hospital accreditation level, underlying comorbidity, and a potentially difficult airway. Patients in the BB group had longer median (interquartile range) stays in the intensive care unit (1 [0-4] vs. 1 [0-3] days, P ＜ 0.001) and in hospital (16 [10-26] vs. 13 [8-22] days, P ＜ 0.001).
Patients undergoing thoracic surgery are more likely to experience postoperative pulmonary complications if a BB than a DLT is used.
在双腔管（DLT）和支气管阻塞器（BB）之间选择用于肺隔离仍然存在争议。本研究的目的是确定这些肺隔离装置的特征是否会影响术后肺部结局。
我们回顾性地从台湾全民健康保险研究数据库中确定了 2000 年至 2012 年期间接受肺隔离手术的患者的理赔记录。在匹配年龄、性别和手术年份后，1898 例患者纳入 BB 组，5694 例患者纳入 DLT 组。使用条件逻辑回归分析估计术后第一年与肺部并发症相关的再入院、住院期间死亡和一年死亡率的风险。
BB 组患者在术后第一年因肺部感染（调整后的优势比 [aOR]，1.46；95%置信区间 [CI]，1.22-1.74）或呼吸衰竭（aOR，1.38；95% CI，1.09-1.76）需要再入院的风险更高，以及住院期间死亡（aOR，2.03；95% CI，1.40-2.94）和一年死亡率（aOR，1.94；95% CI，1.60-2.35）均高于 DLT 组，调整手术类型、医院认证级别、潜在的困难气道和基础合并症后。BB 组患者入住重症监护病房的中位数（四分位距）时间更长[1（0-4）天比 1（0-3）天，P ＜0.001]，住院时间更长[16（10-26）天比 13（8-22）天，P ＜0.001]。
与 DLT 相比，使用 BB 进行胸外科手术的患者更有可能发生术后肺部并发症。
