【原】左側(cè)雙腔支氣管導(dǎo)管與氣管和支氣管尺寸的相容性：一項(xiàng)回顧性比較研究

罌粟花anesthGH 2022-06-21 發(fā)布于貴州

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左側(cè)雙腔支氣管導(dǎo)管與氣管和支氣管尺寸的相容性：一項(xiàng)回顧性比較研究

貴州醫(yī)科大學(xué) 麻醉與心臟電生理課題組

翻譯：陳銳編輯：張中偉審校：曹瑩

背景

雙腔支氣管導(dǎo)管 (DLT) 仍然是麻醉期間獲得肺隔離的最廣泛使用的方法。我們比較了DLT大小選擇的建議與從大量患者群體中收集的經(jīng)放射學(xué)評(píng)估的下氣道尺寸。

方法

在這項(xiàng)回顧性比較研究中，我們?cè)u(píng)估了150名沒(méi)有已知?dú)獾啦∽兊某赡耆说挠?jì)算機(jī)斷層掃描 (CT) 掃描。使用這些掃描，我們測(cè)量了氣管的直徑和長(zhǎng)度以及主支氣管的直徑。然后將這些氣道尺寸與三個(gè)不同制造商的左側(cè)DLT的尺寸進(jìn)行比較。尺寸選擇基于米勒麻醉學(xué)的建議。

結(jié)果

我們發(fā)現(xiàn)推薦的 DLT 尺寸偶爾會(huì)太小，但通常會(huì)太大，尤其是在支氣管內(nèi)氣道中。使用 DLT Vivasight-DL ?時(shí)，28.7% (43/150) 的患者發(fā)生在遠(yuǎn)端主支氣管和 8% (12/150) 的氣管水平。這種不匹配最常見于女性（左遠(yuǎn)端主支氣管34/68，50%；氣管 9/68，13.2%）。相反，對(duì)于男性患者來(lái)說(shuō)，左主支氣管(SHER-I-BRONCH ? : 8/82, 9.8%) 和氣管 (SHER-I-BRONCH ? : 2/82, 2.4% )的DLT往往太?。?。女性的支氣管內(nèi)管部分通常太長(zhǎng)（Vivasight ?DLT：11/68,16%) 高于男性 (9/82,11%)。

結(jié)論：來(lái)自所有三個(gè)制造商的推薦 DLT 尺寸中有相當(dāng)一部分與個(gè)體患者的下氣道尺寸不相容。

原始文獻(xiàn)來(lái)源:

Jan ELLENSOHN, Thomas HILLERMANN, Andreas STEINAUER et.al.Compatibility of left-sided double-lumen endobronchial tubes with tracheal and bronchial dimensions: a retrospective comparative study.[J].Minerva Anestesiologica 2021 Sep 16 DOI:10.23736/S0375-9393.21.15760-8

英文原文：

Compatibility of left-sided double-lumen endobronchial tubes with tracheal and bronchial dimensions: a retrospective comparative study

Abstract

Background: Double-lumen endobronchial tubes (DLT) continue to be the most widely used method for obtaining lung isolation during anesthesia. We compared recommendations for DLT size selection with radiologically assessed lower airway dimensions gathered from a large patient population.

Methods: For this retrospective comparative study, we assessed computed tomography (CT) scans of 150 adults with no known airway pathologies. Using these scans, we measured the diameter and length of the trachea and the diameter of the mainstem bronchi. These airway dimensions were then compared to the dimensions of left-sided DLTs of three different manufacturers. Size selection was based on one standard textbook's recommendations.

Results: We found the recommended DLT sizes were occasionally too small but more often too large, particularly in the endobronchial airway. With the DLT Vivasight-DL?, mismatching occurred in 28.7% (43/150) of the patients at the distal mainstem bronchus and 8% (12/150) at the tracheal level. This mismatching happened most often in females (left distal mainstem bronchus 34/68, 50%; trachea 9/68, 13.2%). Conversely, the DLT was more often too small for male patients in both the left main bronchus (SHER-I-BRONCH?: 8/82, 9.8%) and the trachea (SHER-I-BRONCH?: 2/82, 2.4%). The endobronchial tube portion was more often too long in females (Vivasight? DLT: 11/68, 16%) than males (9/82, 11%).

Conclusions: A considerable proportion of the recommended DLT sizes from all three manufacturers was incompatible with individual patient's lower airway dimensions.