左双腔气管导管两种插管方法的比较

Comparison of Two Methods With a Left-Sided Double-Lumen Tube for Endobronchial Intubation

目的探讨头正中位左双腔气管导管(DLT)逆时针旋转90°与头右偏位左DLT逆时针旋转180°两种插管方法的左主支气管插管成功率。方法选取2021年12月至2022年6月北京协和医院胸外科拟接受左DLT插管的肺切除术患者648例,随机分为90°组和180°组,每组324例,其中,90°组采用患者头正中位、左DLT支气管套囊越过声门后逆时针旋转90°的传统插管方法进行插管;180°组采用患者头右偏位、左下颌角与胸骨正中对齐左DLT逆时针旋转180°的方法进行插管。比较两组患者左DLT置入左主支气管的插管成功率以及隆突黏膜损伤情况。结果648例患者中,男336例,女312例,年龄39.0~75.0岁,平均(54.6±9.0)岁。90°组和180°组首次插管成功率分别为80.3%、75.0%,差异无统计学意义(P=0.109)。180°组第2次插管成功率显著高于90°组(P<0.001)。90°组和180°组插管后隆突黏膜损伤率分别为23.8%、25.6%,差异无统计学意义(P=0.585)。结论与传统插管方法相比,患者头右偏位、左DLT逆时针旋转180°的插管方法不能提高首次左主支气管插管的成功率,但作为一种补救插管方法可以提高再次左主支气管插管的成功率。

Objective To compare the success rates of two methods for endobronchial intubation:the left-sided double-lumen tube(DLT)rotated 90°counter-clockwise with the patient head at the mid positon and the tube rotated 180°counter-clockwise with the patient head turned to the right.Methods Six hundred and forty-eight patients were enrolled in this study,who were to undergo elective thoracic surgery by left-sided DLT intubation in the Peking Union Medical College Hospital from December 2021 to June 2022.They were randomized into a 90°group and a 180°group,with 324 patients in each group.In the 90°group,with the patient head kept at the mid position,the left-sided DLT was advanced until the bronchial cuff passed the vocal cords and then rotated 90°counter-clockwise.In the 180°group,with the left mandible angle of each patient in the straight line with the sternum,the tube was advanced until the bronchial cuff passed the vocal cords and then rotated 180°counter-clockwise.The intubation success rate and the intubation-related complications such as carina mucosal injuries were compared between the two groups.Results The 648 patients included 336 males and 312 females,with the age ranging from 39.0 to 75.0 years old and the average age of(54.6±9.0)years old.The success rate of first intubation was 80.3%in the 90°group and 75.0%in the 180°group,which showed no significant difference(P=0.109).The success rate of second intubation was higher in the 180°group than in the 90°group(P<0.001).The rate of carina mucosal injuries was 23.8%in the 90°group and 25.6%in the 180°group,which showed no significant difference(P=0.585).Conclusions Compared with the conventional method(90°),the intubation of the left-sided DLT rotated 180°counter-clockwise with the patient head turned to the right cannot improve the success rate of the first intubation.However,it could improve the success rate of reintubation as a remedy.