中国食管癌切除术术后肺炎与 DLT 与 SLT 的相关性：一项回顾性比较研究。

Association of DLT versus SLT with postoperative pneumonia during esophagectomy in China: a retrospective comparison study.

机构信息

Department of Anesthesiology, the First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Jinping District, Shantou City, Guangdong Province, China.

出版信息

BMC Anesthesiol. 2023 Sep 5;23(1):301. doi: 10.1186/s12871-023-02252-4.

DOI:10.1186/s12871-023-02252-4

PMID:37670237

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10478392/

Abstract

BACKGROUND

Double lumen tube (DLT) and single lumen tube (SLT) are two common endotracheal tube (ETT) types in esophageal cancer surgery. Evidence of the relationship between two ETT types and postoperative pneumonia (PP) remains unclear. We aimed to determine the association between two types of ETT (DLT and SLT) and PP and assess the perioperative risk-related parameters that affect PP.

METHODS

This study included 680 patients who underwent esophageal cancer surgery from January 01, 2010 through December 31, 2020. The primary outcome was PP, and the secondary outcome was perioperative risk-related parameters that affect PP. The independent variable was the type of ETT: DLT or SLT. The dependent variable was PP. To determine the relationship between variables and PP, univariate and multivariate analyses were performed. The covariables included baseline demographic characteristics, comorbidity disease, neoadjuvant chemotherapy, tumor location, laboratory parameters, intraoperative related variables.

RESULTS

In all patients, the incidence of postoperative pneumonia in esophagectomy was 32.77% (36.90% in DLT group and 26.38% in SLT group). After adjusting for potential risk factors, we found that using an SLT in esophagectomy was associated with lower risk of postoperative pneumonia compared to using a DLT (Odd ratio = 0.41, 95% confidence interval (CI): 0.22, 0.77, p = 0.0057). Besides DLT, smoking history, combined intravenous and inhalation anesthesia (CIIA) and vasoactive drug use were all significant and independent risk factors for postoperative pneumonia in esophagectomy. These results remained stable and reliable after subgroup analysis.

CONCLUSIONS

During esophagectomy, there is significant association between the type of ETT (DLT or SLT) and PP. Patients who were intubated with a single lumen tube may have a lower rate of postoperative pneumonia than those who were intubated with a double lumen tube. This finding requires verification in follow-up studies.

摘要

背景

双腔管（DLT）和单腔管（SLT）是食管癌手术中两种常见的气管内管（ETT）类型。两种 ETT 类型与术后肺炎（PP）之间的关系证据仍不清楚。我们旨在确定两种 ETT 类型（DLT 和 SLT）与 PP 的关系，并评估影响 PP 的围手术期相关风险参数。

方法

本研究纳入了 2010 年 1 月 1 日至 2020 年 12 月 31 日期间接受食管癌手术的 680 例患者。主要结局是 PP，次要结局是影响 PP 的围手术期相关风险参数。自变量是 ETT 类型：DLT 或 SLT。因变量是 PP。为了确定变量与 PP 之间的关系，进行了单因素和多因素分析。协变量包括基线人口统计学特征、合并症疾病、新辅助化疗、肿瘤位置、实验室参数、术中相关变量。

结果

在所有患者中，食管癌手术后肺炎的发生率为 32.77%（DLT 组为 36.90%，SLT 组为 26.38%）。在调整了潜在风险因素后，我们发现与使用 DLT 相比，在食管癌手术中使用 SLT 与术后肺炎的风险较低相关（比值比=0.41，95%置信区间（CI）：0.22，0.77，p=0.0057）。除了 DLT 之外，吸烟史、静脉和吸入联合麻醉（CIIA）和血管活性药物的使用也是食管癌手术后肺炎的显著和独立危险因素。这些结果在亚组分析后仍然稳定可靠。