Li Jiayun, Liu Wu, Liang Xi, Zhou Ren, Wang Mingsong, Hu Beibei, Jiang Hong, Hu Rong
Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Centre for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China.
Department of Thoracic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Centre for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China.
J Thorac Dis. 2024 Nov 30;16(11):7729-7738. doi: 10.21037/jtd-24-1516. Epub 2024 Nov 29.
The inflated balloon of a bronchial blocker (BB) obstructs the mainstem bronchus, allowing controlled ventilation of one lung while collapsing the other for lung isolation during thoracic surgery. We compared the effects of lung isolation using electromagnetic navigation bronchoscopy (ENB)-guided versus fiberoptic bronchoscopy (FOB)-guided BB placement to provide a novel BB positioning method for airway management during thoracic anesthesia.
We randomly divided 106 patients who underwent elective one-lung ventilation (OLV) with intraoperative ENB usage into ENB and FOB groups. We compared subjective lung collapse scores, time required for correct BB placement, incidence of BB malposition, and frequency of intraoperative BB repositioning with FOB between the groups. Heart rate (HR) and mean arterial pressure were recorded before intubation of single-lumen tracheal tube, and before and after BB positioning. Blood gas levels were measured before and at 10 and 30 min after initiating OLV. Postoperative follow-up indices, including blood cell analysis, C-reactive protein levels, and pulmonary complications, were also recorded.
The subjective lung collapse score was significantly higher in the ENB group than in the FOB group [9.08 (1.36) 8.24 (1.93), P=0.01]. The time required for correct BB placement was significantly shorter in the ENB group than in the FOB group [13.00 (10.00, 20.25) 49.00 (35.00, 75.00), P<0.001]. However, the incidence of BB malposition, frequency of intraoperative BB repositioning with FOB, HR, mean arterial and peak airway pressure before and after BB positioning, arterial blood gas analysis, and postoperative follow-up indices did not differ significantly between the two groups.
ENB-guided BB positioning is an efficient method of lung isolation, demonstrating superior and more rapid lung collapse effects compared with conventional FOB-guided BB placement.
The trial was registered on China Clinical Trial Registry (registration No. ChiCTR2300076133).
支气管封堵器（BB）的膨胀球囊可阻塞主支气管，在胸外科手术中实现单肺通气的同时使另一侧肺萎陷，以进行肺隔离。我们比较了电磁导航支气管镜（ENB）引导与纤维支气管镜（FOB）引导下放置BB进行肺隔离的效果，旨在为胸段麻醉期间的气道管理提供一种新的BB定位方法。
我们将106例术中使用ENB进行择期单肺通气（OLV）的患者随机分为ENB组和FOB组。比较两组主观肺萎陷评分、正确放置BB所需时间、BB位置不当的发生率以及术中使用FOB重新定位BB的频率。记录单腔气管插管前、BB定位前后的心率（HR）和平均动脉压。在开始OLV前、10分钟和30分钟时测量血气水平。还记录术后随访指标，包括血细胞分析、C反应蛋白水平和肺部并发症。
ENB组的主观肺萎陷评分显著高于FOB组[9.08（1.36）比8.24（1.93），P = 0.01]。ENB组正确放置BB所需时间显著短于FOB组[13.00（10.00，20.25）比49.00（35.00，75.00），P < 0.001]。然而，两组之间BB位置不当的发生率、术中使用FOB重新定位BB的频率、BB定位前后的HR、平均动脉压和气道峰值压力、动脉血气分析以及术后随访指标并无显著差异。
ENB引导下放置BB是一种有效的肺隔离方法，与传统的FOB引导下放置BB相比，具有更好、更快的肺萎陷效果。
该试验已在中国临床试验注册中心注册（注册号：ChiCTR2300076133）。
