视频双腔管对胸外科手术患者插管并发症的影响：一项随机对照研究。

The effects of video double-lumen tubes on intubation complications in patients undergoing thoracic surgery: A randomised controlled study.

机构信息

From the Jiangsu Province Key laboratory of Anaesthesiology, Xuzhou Medical University (WS, WH, YS, ZD, SZ), Department of Anaesthesiology, Xuzhou Cancer Hospital, Xuzhou (WM, YH, SZ, LH, SZ), California State University, Los Angeles, USA (IYH) and Jiangsu University, Zhenjiang, Jiangsu, China (YG).

出版信息

Eur J Anaesthesiol. 2024 Apr 1;41(4):305-313. doi: 10.1097/EJA.0000000000001959. Epub 2024 Jan 30.

DOI:10.1097/EJA.0000000000001959

PMID:38298060

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10906194/

Abstract

BACKGROUND

Tracheal injuries, vocal cord injuries, sore throat and hoarseness are common complications of double-lumen tube (DLT) intubation.

OBJECTIVE

This study aimed to evaluate the effects of 'video double-lumen tubes' (VDLTs) on intubation complications in patients undergoing thoracic surgery.

DESIGN

A randomised controlled study.

SETTINGT

Xuzhou Cancer Hospital, Xuzhou, China, from January 2023 to June 2023.

PATIENTS

One hundred eighty-two patients undergoing elective thoracic surgery with one-lung ventilation were randomised into two groups: 90 in the DLT group and 92 in the VDLT group.

INTERVENTION

VDLT was selected for intubation in the VDLT group, and DLT was selected for intubation in the DLT group. A fibreoptic bronchoscope (FOB) was used to record tracheal and vocal cord injuries.

MAIN OUTCOME MEASURES

The primary outcomes were the incidence of moderate-to-severe tracheal injury and the incidence of vocal cord injury. The secondary outcomes included the incidence and severity of postoperative 24 and 48 h sore throat and hoarseness.

RESULTS

The incidence of moderate-to-severe tracheal injury was 32/90 (35.6%) in the DLT group, and 45/92 (48.9%) in the VDLT group ( P = 0.077; relative risk 1.38, 95% CI, 0.97 to 1.95). The incidence of vocal cord injury was 31/90 (34.4%) and 34/92 (37%) in the DLT and VDLT groups, respectively ( P = 0.449). The incidence of postoperative 24 h sore throat and hoarseness was significantly higher in the VDLT group than in the DLT group (for sore throat: P = 0.032, relative risk 1.63, 95% CI, 1.03 to 2.57; for hoarseness: P = 0.018, relative risk 1.48, 95% CI, 1.06 to 2.06).

CONCLUSION

There was no statistically significant difference in the incidence of moderate-to-severe tracheal injury and vocal cord injury between DLTs and VDLTs. While improving the first-attempt success rate, intubation with VDLT increased the incidence of postoperative 24 h sore throat and hoarseness.

TRIAL REGISTRATION

Chinese Clinical Trial Registry identifier: ChiCTR2300067348.

摘要

背景

气管损伤、声带损伤、咽痛和声音嘶哑是双腔管（DLT）插管的常见并发症。

目的

本研究旨在评估“视频双腔管”（VDLTs）在接受胸腔手术的患者中对插管并发症的影响。

设计

随机对照研究。

地点

中国徐州 2023 年 1 月至 6 月的徐州肿瘤医院。

患者

182 例择期行单肺通气胸腔手术的患者被随机分为两组：90 例 DLT 组和 92 例 VDLT 组。

干预措施

VDLT 组选择 VDLT 进行插管，DLT 组选择 DLT 进行插管。使用纤维支气管镜（FOB）记录气管和声带损伤。

主要观察指标

主要结局是中重度气管损伤的发生率和声带损伤的发生率。次要结局包括术后 24 小时和 48 小时咽痛和声音嘶哑的发生率和严重程度。

结果

DLT 组中重度气管损伤发生率为 32/90（35.6%），VDLT 组为 45/92（48.9%）（P=0.077；相对风险 1.38，95%CI，0.97 至 1.95）。DLT 组和 VDLT 组声带损伤的发生率分别为 31/90（34.4%）和 34/92（37%）（P=0.449）。术后 24 小时咽痛和声音嘶哑的发生率在 VDLT 组明显高于 DLT 组（咽痛：P=0.032，相对风险 1.63，95%CI，1.03 至 2.57；声音嘶哑：P=0.018，相对风险 1.48，95%CI，1.06 至 2.06）。