Wang Zhenzhong, Zhao Junfei, Ke Yingjie, Wang Qiuji, Li Yuxin, Ye Yingxian, Zhang Jianjun, Guo Xiaogang, Zeng Qingshi, Huang Huanlei
Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.
Department of Anaesthesia, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.
Front Cardiovasc Med. 2025 Jul 24;12:1583360. doi: 10.3389/fcvm.2025.1583360. eCollection 2025.
One-lung ventilation (OLV) with double-lumen tubes (DLT) are prone to complications such as airway injury and hypoxemia. It is not clear whether a two-lung ventilation (TLV) with single-lumen tube (SLT) is beneficial for patients undergoing totally endoscopic cardiac valve surgery (TECVS).
We conducted a pragmatic, single-centre, single-blinded randomised controlled trial. Patients (aged ≥18 years) who underwent total endoscopic cardiac valve surgery were randomly assigned to a DLT group or a SLT group. A two-week telephone follow-up was conducted. The oxygenation index (PaO/FiO) was the primary outcome. The secondary outcomes included PaCO, postoperative intubation complications, postoperative pulmonary complications and airway injury.
A total of 220 patients were randomly assigned. After randomisation, 20 patients were excluded, leaving 100 patients in each of the two groups. The PaO/FiO were significantly greater in the SLT group than in the DLT group ( < 0.001). The incidence of postoperative intubation adverse events, postoperative pulmonary atelectasis, and hoarseness was significantly lower in the SLT group ( < 0.001, = 0.029 and = 0.028, respectively). The pre-exposure time and intubation time were shorter in the SLT group (both values < 0.001). We used test, Mann-Whitney test and Fisher's exact test to account the difference of perioperative and follow-up outcomes.
Two-lung ventilation with single-lumen tube is easy to perform, significantly increases oxygenation, and decreases the incidence of postoperative complications and airway injuries. Advantages remain especially for patients with preoperative pulmonary dysfunction.
https://www.chictr.org.cn/showproj.html?proj=165709, identifier [ChiCTR2200066822]. Date: 19/12/2022.
使用双腔气管导管（DLT）进行单肺通气（OLV）容易出现气道损伤和低氧血症等并发症。对于接受全胸腔镜心脏瓣膜手术（TECVS）的患者，使用单腔气管导管（SLT）进行双肺通气（TLV）是否有益尚不清楚。
我们开展了一项实用的单中心单盲随机对照试验。将接受全胸腔镜心脏瓣膜手术的患者（年龄≥18岁）随机分为DLT组或SLT组。进行为期两周的电话随访。氧合指数（PaO₂/FiO₂）为主要结局指标。次要结局指标包括PaCO₂、术后插管并发症、术后肺部并发症和气道损伤。
共有220例患者被随机分组。随机分组后，排除20例患者，两组各留100例患者。SLT组的PaO₂/FiO₂显著高于DLT组（P<0.001）。SLT组术后插管不良事件、术后肺不张和声音嘶哑的发生率显著更低（分别为P<0.001、P = 0.029和P = 0.028）。SLT组的预暴露时间和插管时间更短（均P值<0.001）。我们使用t检验、Mann-Whitney U检验和Fisher精确检验来分析围手术期和随访结局的差异。
使用单腔气管导管进行双肺通气操作简便，能显著提高氧合，降低术后并发症和气道损伤的发生率。对于术前存在肺功能障碍的患者，优势尤为明显。
https://www.chictr.org.cn/showproj.html?proj=165709，标识符[ChiCTR2200066822]。日期：2022年12月19日。
