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单腔与双腔气管插管对肺移植患者术后吞咽功能的影响:一项单中心回顾性队列研究

Impact of Single-Lumen Versus Double-Lumen Endotracheal Tube on Postoperative Swallowing Function in Lung Transplantation Patients: A Single-Center, Retrospective Cohort Study.

作者信息

Patel Rishi Ashok, Nitchie Haley, Wolf Bethany J, Taylor Cecilia, Francis Loren

机构信息

Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.

Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.

出版信息

J Clin Med. 2025 Apr 29;14(9):3075. doi: 10.3390/jcm14093075.

Abstract

: The role of double-lumen endotracheal tube (DLT) versus single-lumen endotracheal tube (SLT) use during lung transplantation (LTx) and its effects on postoperative dysphagia have not yet been studied. It has been shown that new-onset oropharyngeal dysphagia (OPD) is common after various thoracic surgeries including lung transplantation and that OPD is associated with increased postoperative complications. : A single-center, retrospective cohort study was performed using a data exploration tool in the electronic medical record. Data included demographic characteristics, medical history, postoperative dysphagia measured by Functional Oral Intake Scale (FOIS) via modified barium swallow study (MBSS) within 5 days of surgery, and other secondary outcomes. In univariate analysis, participants who had a DLT (49 patients) had significantly higher FOIS scores (indicating better swallowing function) as compared to those with an SLT (21 patients) ( = 0.035). Lumen type remained significant in a multivariable model, with use of a DLT showing more than a 5-fold increase in the odds of a higher FOIS score after controlling for other factors ( = 0.004; cumulative OR (95% CI): 5.2 (1.7-15.9)). Participants who had a DLT had shorter hospital length of stay (LOS) ( = 0.017; single 18 days (IQR = 13), double 14 days (IQR 7)). Those who had a DLT experienced significantly greater ventilator-free time at postoperative day 30 compared to those who received an SLT ( = 0.018). ICU LOS was similar between those who received a DLT vs. SLT. : Overall, DLT seems to confer reduced new-onset OPD after lung transplantation surgery when compared with SLT. The use of DLT instead of SLT for lung isolation for LTx may have the potential to reduce morbidity and mortality in this population.

摘要

在肺移植(LTx)过程中使用双腔气管内导管(DLT)与单腔气管内导管(SLT)的作用及其对术后吞咽困难的影响尚未得到研究。研究表明,包括肺移植在内的各种胸科手术后,新发口咽吞咽困难(OPD)很常见,且OPD与术后并发症增加有关。:使用电子病历中的数据探索工具进行了一项单中心回顾性队列研究。数据包括人口统计学特征、病史、术后5天内通过改良吞钡造影研究(MBSS)使用功能性口服摄入量量表(FOIS)测量的术后吞咽困难,以及其他次要结果。在单变量分析中,与使用SLT的患者(21例)相比,使用DLT的患者(49例)的FOIS评分显著更高(表明吞咽功能更好)(P = 0.035)。在多变量模型中,管腔类型仍然具有显著性,在控制其他因素后,使用DLT显示FOIS评分较高的几率增加了5倍以上(P = 0.004;累积OR(95%CI):5.2(1.7 - 15.9))。使用DLT的患者住院时间较短(P = 0.017;单腔18天(IQR = 13),双腔14天(IQR 7))。与接受SLT的患者相比,接受DLT的患者在术后第30天的无呼吸机时间显著更长(P = 0.018)。接受DLT与SLT的患者在重症监护病房(ICU)的住院时间相似。:总体而言,与SLT相比,DLT似乎能降低肺移植手术后新发OPD的发生率。在LTx中使用DLT而非SLT进行肺隔离可能有降低该人群发病率和死亡率的潜力。

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