两种导管塑形方法在视可尼喉镜引导双腔气管导管插管中的比较

Comparison of two shaping methods for double-lumen endotracheal tube intubation by Shikani optical stylet laryngoscope

目的:采用视可尼喉镜引导双腔气管导管插管,将导管气管腔开口分别置于塑形后导管远端弯曲的凸面和凹面,比较这两种不同塑形方法在插管时的有效性和安全性。方法:对行择期胸外科手术并需进行左双腔气管导管插管的患者,采用视可尼喉镜引导双腔气管导管插管,根据气管导管塑形方式将患者随机分为U组和T组,患者使用的双腔气管导管均沿视可尼喉镜镜杆塑形,T组塑性后导管的气管腔开口置于导管远端弯曲的凸面,U组气管腔开口置于导管远端弯曲的凹面。全麻诱导后,采用塑形后的导管在视可尼喉镜引导下插管,记录患者视可尼喉镜插管操作时间、插管次数、支气管插管错位、纤维支气管镜定位时间、插管总时间及是否有口唇和牙齿损伤,评估术后1 h及24 h患者声音嘶哑及咽喉疼痛情况。结果:136例患者完成本研究,每组68例。U组患者视可尼插管操作时间少于T组[(35.1±6.1)s vs.39.6±11.8)s,P=0.007],两组一次插管成功率(92.6%vs.88.2%,P=0.561)差异无统计学意义;U组插管阻力评分更低;T组支气管插管错位的例数少于U组(4 vs.13,P=0.020),纤维支气管镜定位时间更短[(44.1±20.9)s vs.(53.6±29.2)s,P=0.032];两组患者插管总时间以及两组口唇、牙齿损伤发生率差异均无统计学意义;声音嘶哑发生率和严重程度评估,术后1 h时U组均低于T组;而在咽喉疼痛发生率和严重程度方面,术后1 h和24 h时U组均低于T组。结论:使用视可尼喉镜引导左双腔气管导管插管时,将导管沿视可尼镜杆塑形,使其气管腔开口位于塑形后导管远端弯曲的凹面能够节省视可尼喉镜插管操作时间,并减少术后咽喉疼痛及声音嘶哑的发生率和严重程度,但这种塑形方法会增加支气管插管错位的发生率以及纤维支气管镜定位导管位置所花费的时间。

Objective： To compare the efficacy and safety of two different shaping methods for doublelumen endotracheal tube（ DLT）. DLT was shaped with the rod of a Shikani optical stylet（ SOS） with the tracheal orifice aligned with the convex aspect of the distal curvature or the concave aspect of the distal curvature. Methods： Patients scheduled for elective thoracic surgery and required intubation with a leftsided DLT were enrolled in this study. They were randomized into two groups. They were intubated with a DLT,which was shaped with the rod of a SOS with its tracheal orifice aligned with the convex aspect of the distal curvature（ group T） or the concave aspect of the distal curvature（ group U）. Time for SOS manipulation,intubation attempts,intubation resistance score,malposition of bronchial intubation,time for fiberoptic bronchoscope（ FOB） identification of bronchial placement,total intubation time and oral mucosal or dental injury were recorded. Hoarseness and throat sore of the patients were evaluated 1 hour and 24 hours after surgery. Results： A total of 136 patients completed the study,with 68 in each group.Time for SOS manipulation was significantly shorter in group U [（ 35. 1 ± 6. 1） s vs. 39. 6 ± 11. 8） s,P = 0. 007]. First attempt success rate did not differ between the groups（ 92. 6% vs. 88. 2%,P =0. 561）. Intubation resistance score was significantly lower in group U. Group T had fewer patients who suffered malposition of bronchial intubation than group U（ 4 vs. 13,P = 0. 020） and cost less time for FOB identification of bronchial placement [（ 44. 1 ± 20. 9） s vs.（ 53. 6 ± 29. 2） s,P = 0. 032]. Total intubation time and the incidence of oral mucosal or dental injury did not differ between the groups. The severity and incidence of hoarseness were lower in group U than in group T 1 hour after surgery. The severity and incidence of sore throat were lower in group U than in group T 1 hour and 24 hours postopera-tively. Conclusion： When lacing a left-sided DLT using a SOS,shaping the DLT with the tracheal orifice aligned with the concave aspect of the distal curvature saves SOS manipulation time,decreases the severity and incidence of postoperative hoarseness and sore throat. However,this modified shaping method increases the incidence of malposition of bronchial intubation and time for FOB identification of bronchial placement.