侧卧位可视喉镜下行VivaSight双腔支气管插管的临床研究

Clinical study of VivaSight double-lumen endobronchial tube intubation under visual laryngoscope in lateral position

目的探讨侧卧位可视喉镜下行VivaSight双腔支气管导管(VDLT)插管是否安全有效。方法选取北京航天总医院胸外科2021-04/2022-04期间择期行胸腔镜手术患者60例,采用随机数字表法分为仰卧位插管组(S组,n=30)和侧卧位插管组(L组,n=30)。L组患者自主摆放侧卧位后行麻醉插管;S组患者仰卧位麻醉插管后摆放侧卧位。观察并记录2组患者侧卧位摆放所需医护人员数量、侧卧位摆放时间、Cormach-Lehane声门显露分级、插管次数、插管时间;麻醉诱导前(T_(1))、插管前即刻(T_(2))、暴露声门时(T_(3))、VDLT置入左主支气管后1 min(T_(4))、插管完成后3 min(T_(5))、插管完成后5 min(T_(6))的血压和心率;摆体位后VDLT移位情况,患者术后咽喉疼痛、声音嘶哑等不良反应。结果相较于S组,L组患者摆体位人数更少,时间更短,VDLT移位例数更少,插管相关并发症更少(P<0.05);2组患者声门显露分级、插管次数、插管时间、血压和心率比较,差异无统计学意义(P>0.05)。结论胸外科手术患者侧卧位可视喉镜下行VDLT插管安全有效。

Objective To investigate the feasibility and safety of VivaSight double-lumen endobronchial tube(VDLT)intubation under visual laryngoscope in lateral position.Mehtods Sixty patients scheduled for elective thoracic surgery in Beijing Aerospace General Hospital from April 2021 to April 2022 were divided into two groups,lateral position intubation group(group L,n=30)and supine position intubation group(group S,n=30),according to random number table mehtod.Patients in group L were placed in lateral position all by themselves and then intubated under general ansthesia.Patients in group S were intubated first and placed in lateral position later.The number of medical workers involved in placing the lateral position and the time needed,Cormach-Lehane grade,intubation attempts and intubation time were recorded.Blood pressure and heart rate before anesthesia induction(T_(1)),immediately before intubation(T_(2)),on exposure of glottis(T_(3)),1 min after intubation(T_(4)),3 min after intubation(T_(5))and 5 min after intubation(T_(6))were also recorded.The incidence of VDLT displacement,sore throat and hoarseness of the patients after surgery were evaluated.Results Compared with group S,the number of medical workers involved was fewer,the time needed to place the lateral position was shorter,the incidence of VDLT displacement and postoperative complications related to intubation were less than those in group L(P<0.05).There were no significant difference in the Cormach-Lehane grade,intubation attempts,intubation time,blood pressure and heart rate at T_(1),T_(2),T_(3),T_(4),T_(5)and T_(6)between the two groups(P>0.05).Conclusion VDLT intubation under visual laryngoscope in lateral position is safe and feasible,which can be applied to patients undergoing thoracic surgery.