三种方法测量胸部 CT 引导下右侧双腔管右主支气管长度准确性的比较。
Comparison of the accuracy of three methods measured the length of the right main stem bronchus by chest computed tomography as a guide to the use of right sided double-lumen tube.
机构信息
Department of Anesthesiology, First Hospital of Qinhuangdao, N.O. 258, Wenhua Road, Qinhuangdao, Hebei, China.
Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China.
出版信息
BMC Anesthesiol. 2022 Aug 18;22(1):264. doi: 10.1186/s12871-022-01744-z.
BACKGROUND
The variation of right main stem bronchus leads to the orifice of the right upper lobe bronchus may be obstructed or increase the incidence of malposition intraoperatively when the right sided double-lumen tube is used. Therefore, the aim of this study was to compare the accuracy of three methods measured the length of the right main stem bronchus via chest computed tomography as a guide to the use of right sided double-lumen tube.
METHODS
In this study, 168 adult patients undergoing left sided thoracic surgery were included. All these patients were allocated to carina-proximal (C-P) group, carina-distal (C-D) group and carina-carina (C-C) group. The position of endobronchial cuff observed via Fiberoptic bronchoscopy after successful initial placement and after turning the patients to the lateral decubitus position, as well as the incidence of malposition of right sided double-lumen tube intraoperative were recorded to assess the accuracy of three methods in predicting the position of right sided double-lumen tube.
RESULTS
The distance between the carina to the proximal margin of the right upper lobe orifice, carina to the distal margin of the right upper lobe orifice and carina to the first right interlobar carina of the right upper lobe orifice were 17.2 ± 2.3 mm, 25.4 ± 3.7 mm and 28.5 ± 3.1 mm (P < 0.05). In the C-D group, the number of endobronchial cuffs seen to be herniating out of the carina, the number of bronchoscopies during initial placement and on the lateral position, the number of total malposition intraoperative and the number of reposition manoeuvres intraoperative were significantly less than the C-P group or the C-C group (P < 0.05).
CONCLUSIONS
The length of the right main stem bronchus measured by the carina to distal margin of right upper lobe orifice method was more accurate than the other two methods in guiding the use of right sided double-lumen tube.
TRIALS REGISTRATION
Clinical Trials. gov. no. NCT04127903. Registered at https://register.
CLINICALTRIALS
gov on 16/10/2019.
背景
右主支气管的变异可能导致右上叶支气管的开口受阻，或者在使用右侧双腔管时增加术中错位的发生率。因此，本研究旨在比较三种通过胸部计算机断层扫描测量右主支气管长度的方法的准确性，以指导右侧双腔管的使用。
方法
本研究纳入了 168 例接受左侧开胸手术的成年患者。所有患者均分为隆突近端（C-P）组、隆突远端（C-D）组和隆突隆突（C-C）组。通过纤维支气管镜观察初始放置后和患者转为侧卧位后支气管内套囊的位置，并记录右侧双腔管术中错位的发生率，以评估三种方法预测右侧双腔管位置的准确性。
结果
隆突至右上叶开口近端缘、隆突至右上叶开口远端缘和隆突至右上叶第一叶间裂的距离分别为 17.2±2.3mm、25.4±3.7mm 和 28.5±3.1mm（P<0.05）。在 C-D 组中，支气管内套囊可见隆突突出、初始放置和侧卧位时支气管镜检查次数、术中总错位次数和术中重新定位次数均明显少于 C-P 组或 C-C 组（P<0.05）。
结论
隆突至右上叶开口远端缘的右主支气管长度测量方法在指导右侧双腔管使用方面比其他两种方法更准确。
试验注册
ClinicalTrials.gov. no. NCT04127903. 在 https://register. 注册于 2019 年 10 月 16 日。
临床试验
ClinicalTrials.gov. 号 NCT04127903. 在 https://register. 注册于 2019 年 10 月 16 日。
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