文章摘要
纤维支气管镜经左侧双腔支气管导管右侧管腔引导插管对气管插管定位的影响
Effect of fiberoptic bronchoscope guidance through the right lumen of a left double-lumen tube on tracheal intubation and positioning
  
DOI：10.12089/jca.2025.05.003
中文关键词: 双腔支气管导管  纤维支气管镜  气管插管  并发症
英文关键词: Double-lumen tube  Fiberoptic bronchoscope  Tracheal intubation  Complications
基金项目:江苏省卫生健康委医学科研立项项目（Z2020029）；江苏省肿瘤医院科技发展基金（ZL202306）；江苏省肿瘤医院优才基金（YC201805）
作者单位E-mail
金如意 221004,徐州医科大学江苏省麻醉学重点实验室  
包沁雨 221004,徐州医科大学江苏省麻醉学重点实验室  
顾连兵 江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
谭婧 江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
朱秀秀 江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
王丽君 江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科 w_lj2000@hotmail.com 
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中文摘要:
      
目的：探讨纤维支气管镜（FOB）经左侧双腔支气管导管（DLT）右侧管腔引导气管插管定位的临床效果。
方法：选择2023年9月至2024年3月行胸腔镜右侧肺叶或肺段切除术的胸科手术患者60例，男25例，女35例，年龄18～79岁，BMI 18.5～28.0 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：FOB经左侧DLT右侧管腔引导插管组（R组）和盲法插管组（C组），每组30例。在DLT主套囊通过声门后，R组将FOB经左侧DLT右侧管腔置入，至观察到气管隆突，在FOB直视下调整导管尖端进入左主支气管并确定蓝套囊位置；C组采用传统盲插法进行插管，再用FOB完成定位。记录从插管启口至可视喉镜观察到会厌的时间（OMT）、开始插管到气管主套囊通过声门的时间（INT）、DLT继续下行至定位完成的时间（LOT），并计算总插管时间（TOT）。记录插管次数、一次插管成功例数。记录入室时、插管后1、3、5 min的HR、SBP和DBP。记录插管后气管损伤情况、镇痛泵有效按压次数、镇痛泵总按压次数、补救镇痛例数、术后4 d内声音嘶哑、咽喉痛和吞咽痛的发生情况。
结果：与C组比较，R组一次插管成功率明显升高（P＜0.05），气管损伤评分、气管隆突损伤率、术后第1天声音嘶哑和咽喉痛的严重程度明显降低（P＜0.05）。两组OMT、INT、LOT、TOT、入室时、插管后1、3、5 min的HR、SBP和DBP、镇痛泵有效按压次数、镇痛泵总按压次数和补救镇痛率差异均无统计学意义。
结论：与传统盲法插管比较，FOB经左侧DLT右侧管腔引导下的双腔管插管定位，可减少插管定位操作步骤，提高一次插管成功率，减轻气道损伤，降低术后气道并发症发生率。
英文摘要:
      
Objective: To evaluate the clinical efficacy of fiberoptic bronchoscope (FOB)-guided intubation through the right lumen of a left double-lumen tube (DLT) for tracheal intubation and positioning.
Methods: Sixty patients scheduled for video-assisted thoracoscopic surgery (VATS) for right-sided lobectomy or segmentectomy from September 2023 to March 2024, 25 males and 35 females, aged 18-79 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅱ or Ⅲ, were enrolled in this study. Patients were randomly assigned into two groups using a random number table: FOB-guided intubation through the right lumen of a left DLT group (group R) and blind intubation group (group C), 30 patients in each group. In group R, after the main cuff of the DLT passed through the glottis, the FOB was inserted into the right lumen of a left DLT until the carina was visualized. The DLT tip was then advanced into the left main bronchus, and the blue cuff was positioned appropriately under direct FOB visualization. In group C, blind intubation was performed, followed by FOB verification and positioning. Time from opening the patient's mouth to visualizing the epiglottis with a video laryngoscope (opening mouth time, OMT), time from initiating intubation to the passage of the main cuff through the glottis (intubation time, INT), and time from advancing the DLT to completing positioning (location time, LOT) were recorded. The total intubation time (total time, TOT) was calculated. The number of intubation attempts and the number of successful first-attempt intubations were recorded. HR, SBP, and DBP were recorded at baseline and 1 minute, 3, and 5 minutes after intubation. The post-intubation tracheal injury status, number of effective analgesic pump compressions, number of total analgesic pump compressions, cases of requiring rescue analgesia, postoperative airway complications including hoarseness, sore throat, and swallowing pain within the first 4 postoperative days were recorded.
Results: Compared with group C, the rate of first-attempt intubation success was significantly higher in group R (P < 0.05), airway injury scores, the incidence of carinal injuries, and the severity of hoarseness and sore throat on the first postoperative day was significantly lower in group R (P < 0.05). There were no significantly differences in OMT, INT, LOT, and TOT, the HR, SBP, and DBP at baseline, 1 minute, 3, and 5 minutes after intubation, as well as the number of effective compressions of the analgesic pump, the total number of compressions of the analgesic pump, and the rate of using salvage analgesia between the two groups.
Conclusion: Compared with conventional blind intubation, FOB-guided intubation and positioning through the right lumen of a left DLT simplifies the steps of intubation and positioning, improves the first-attempt intubation success rate, reduces airway injury, and lowers the incidence of postoperative airway complications.
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