Lieberman D, Littleford J, Horan T, Unruh H
Department of Anaesthesia, University of Manitoba, Health Sciences Centre, Winnipeg, Canada.
Can J Anaesth. 1996 Mar;43(3):238-42. doi: 10.1007/BF03011741.
This study was designed to determine if leaving a stylet in the left Bronch-Cath endobronchial tube (DLT) for the entire intubating procedure improves the accuracy of placement on the initial attempt, without introducing complications.
Sixty ASA 1-3 patients were randomized to one of two groups. In Group 1 (n = 30), the stylet was retained for the entire intubation procedure and in Group 2 (n = 30), the stylet was removed once the bronchial cuff had passed the vocal cords. In both groups, the DLT was turned 110 degrees counterclockwise and advanced until resistance was encountered. Placement was assessed by auscultation and fibreoptic bronchoscopy (FOB). After surgery, the DLT was replaced by a single-lumen endotracheal tube. The thoracic surgeon (blinded to the method of intubation, and using a FOB) assessed the appearance of the tracheobronchial mucosa.
The two groups were similar with respect to sex, height, weight, DLT size, surgeon and expertise of the laryngoscopist. When the stylet was retained, the DLT was correctly placed 60% of the time compared with 17%, if the stylet was removed, (P = 0.001). Seven out of 30 DLTs in Group 2 were initially placed into the right mainstem bronchus, (P = 0.005). The average time to confirmation of correct tube placement by FOB was increased in Group 2, (P = 0.01). Although the observed incidence of left bronchial, mucosal petechiae and erythema was greater in Group 2, this was not statistically significant, (P = 0.063).
Retaining the stylet for the entire intubation procedure allows for a more rapid, accurate placement of the DLT without increasing the incidence of tracheobronchial mucosa injury.
本研究旨在确定在整个插管过程中，将导丝留在左侧支气管导管（DLT）内是否能提高首次尝试时导管放置的准确性，且不引发并发症。
60例美国麻醉医师协会（ASA）分级为1 - 3级的患者被随机分为两组。在第1组（n = 30）中，导丝在整个插管过程中保留；在第2组（n = 30）中，一旦支气管套囊通过声带，导丝即被移除。两组中，DLT均逆时针旋转110度并推进，直至遇到阻力。通过听诊和纤维支气管镜检查（FOB）评估导管放置情况。术后，DLT被单腔气管导管取代。胸外科医生（对插管方法不知情，使用FOB）评估气管支气管黏膜的外观。
两组在性别、身高、体重、DLT尺寸、外科医生以及喉镜检查者的专业技能方面相似。当保留导丝时DLT正确放置的时间为60%，而移除导丝时为17%，（P = 0.001）。第2组30根DLT中有7根最初被放置到右主支气管，（P = 0.005）。第2组通过FOB确认导管正确放置的平均时间增加，（P = 0.01）。尽管第2组观察到的左支气管黏膜瘀点和红斑的发生率更高，但差异无统计学意义，（P = 0.063）。
在整个插管过程中保留导丝可使DLT更快速、准确地放置，且不增加气管支气管黏膜损伤的发生率。
