肥胖因素对患者体位改变时左侧双腔气管导管移位的影响

Effect of obesity on displacement of left-sided double-lumen tube during positional changes

目的评价肥胖因素对患者体位改变时左侧双腔气管导管(DLT)移位的影响。方法本研究为前瞻性队列研究。选取本院2020年2月至2023年11月行择期胸部手术需插入左侧DLT患者602例,根据BMI将患者分为2组:肥胖组(BMI≥28 kg/m^(2),n=208)和非肥胖组(18.5 kg/m^(2)≤BMI<28 kg/m^(2),n=394)。记录患者一般资料、胸部手术史、DLT型号、仰卧位时DLT置管深度、身高/置管深度(H/D)比值和DLT移位距离。DLT移位定义为移位距离≥15 mm。采用logistic回归法分析BMI与患者体位改变时左侧DLT移位的关系。采用受试者工作特征(ROC)曲线评价BMI预测患者体位改变时左侧DLT移位的准确性。结果与非肥胖组相比,肥胖组DLT置管深度减小,H/D比值升高,DLT移位距离增大,DLT移位发生率升高(P<0.05)。logistic回归分析结果显示,BMI≥28 kg/m^(2)是DLT移位的独立危险因素[校正OR值(95%CI)=4.18(2.36~7.38),P<0.001]。BMI预测患者体位改变时左侧DLT移位的灵敏度为77.4%,特异度为69.6%,最佳截断值为27.48 kg/m^(2),ROC曲线下面积为0.757。结论肥胖因素可增加患者体位改变时左侧DLT移位的概率。

Objective To evaluate the effect of obesity on the displacement of a left-sided double-lumen tube(DLT)during positional changes.Methods This was a prospective cohort study.Six hundred and two patients who underwent elective chest surgery and required insertion of a left-sided DLT from February 2020 to November 2023 in our hospital were selected and divided into 2 groups based on the body mass index(BMI):obesity group(BMI≥28 kg/m^(2),n=208)and non-obesity group(18.5 kg/m^(2)≤BMI<28 kg/m^(2),n=394).General characteristics of patients,history of chest surgery,DLT model,depth of DLT placement in supine position,height/depth of placement(H/D)ratio,and distance of DLT displacement were recorded.DLT displacement was defined as a displacement distance of≥15 mm.The logistic regression was used for analysis of the relationship between BMI and left DLT shift during positional changes.The receiver operating characteristic curve was used to evaluate the accuracy of BMI in predicting the left-sided DLT displacement during positional changes.Results Compared with non-obese group,the depth of DLT placement was significantly reduced,the H/D ratio was increased,the distance of DLT displacement was increased,and the incidence of DLT displacement was increased in obese group(P<0.05).The results of binary logistic regression analysis showed that a BMI≥28 kg/m^(2)was an independent risk factor for DLT displacement(OR value[95%confidence interval]=4.18(2.36-7.38),P<0.001).The sensitivity of BMI in predicting the left-sided DLT displacement during positional changes was 77.4%,and the specificity was 69.6%,with an optimal cutoff value of 27.48 kg/m^(2)and an area under the receiver operating characteristic curve of 0.757.Conclusions Obesity can increase the probability of the left-sided DLT displacement during positional changes.