胸外科手术患者侧位放置支气管阻滞剂进行肺隔离：一项多中心随机临床试验

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-05-13 DOI:10.1016/j.jclinane.2025.111869

Hui Li M.D. , Lihua Chu M.D. , Hui Ye M.D. , Yixiao Zhang M.M. , Min Li M.M. , Yejing Hua M.M. , Jinhua Zhang M.M. , Huiyi Hu M.M. , Tingting Wen M.D. , Jie Zhao M.D. , Haifang Wan M.M. , Lixia Huang M.M. , Yi Lou M.M. , Jing Tang M.D. , Zhenyi Yan M.M. , Gongchen Duan M.M. , Jimin Wu M.D. , Chuanguang Wang M.M. , Yaping Lu M.M. , Xu Shen M.M. , Xiangming Fang M.D.

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引用次数: 0

摘要

研究目的在胸外科手术中，准确的支气管阻滞剂放置对有效的肺隔离至关重要。大约三分之一的患者在从仰卧位到侧卧位的转变过程中出现支气管阻滞剂错位。目前尚不清楚支气管阻滞剂直接放置在侧位是否可以减少体位错位的发生率。本研究调查了侧卧位与仰卧位支气管阻滞剂错位的发生率，并评估侧卧位阻滞剂放置的有效性。患者年龄≥18岁，计划进行胸外科手术。中国七家三级医院干预：支气管阻滞剂放置于侧卧位或仰卧位。主要观察指标为支气管阻滞剂错位的发生率。次要结果包括支气管阻滞剂复位次数、围手术期并发症、插管时间和满意度评分。在接受随机分组的324例患者中，306例完成了研究（侧卧位组152例，仰卧位组154例）。侧卧组支气管阻滞剂错位发生率（1/152(0.7%)）明显低于仰卧组（39/154 (25.3%)），P <；0.001)。侧卧组支气管阻滞剂复位次数（中位数[四分位数间距]:0[0,0]）也低于仰卧组（1.0 [1.0,2.0]），P <；0.001)。侧位支气管阻滞剂放置与较低的体位性损伤发生率相关(P <；0.001)。两组的中位插管时间（单腔管插管加支气管阻滞剂置入）相似（P = 0.089）。患者和外科医生报告外侧组满意度得分较高(P <；0.001)。结论胸外科手术患者侧置支气管阻滞剂可降低体位错位的发生率；并发症更少，满意度更高。这些研究结果表明，侧位置入术是一种有效的方法，与传统的仰卧位置入术相比具有实质性的优势。临床试验注册：NCT05482230。

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Lung isolation with a bronchial blocker placed in the lateral position for patients undergoing thoracic surgery: A multicenter, randomized clinical trial

Study objective

Accurate bronchial blocker placement is essential for effective lung isolation during thoracic surgery. Approximately one-third of patients experience bronchial blocker malposition during the transition from the supine to lateral decubitus position. It has been unclear whether bronchial blocker placement directly in the lateral position can reduce the incidence of malposition. This study investigated the incidence of bronchial blocker malposition in the lateral versus supine position and evaluated the effectiveness of lateral placement.

Patients

Adults aged ≥18 years scheduled for thoracic surgery were enrolled.

Setting

Seven tertiary hospitals in China.

Interventions

Bronchial blockers were placed either in the lateral or supine position.

Measurements

The primary outcome was the incidence of bronchial blocker malposition. Secondary outcomes included the times of bronchial blocker reposition, perioperative complications, intubation duration, and satisfaction scores.

Main results

Among 324 patients who underwent randomization, 306 completed the study (152 in the lateral group and 154 in the supine group). The incidence of bronchial blocker malposition was significantly lower in the lateral group (1/152 (0.7 %)) than in the supine group 39/154 (25.3 %), P < 0.001). The times of bronchial blocker reposition was also lower in the lateral group (median [interquartile range]: 0 [0,0]) than in the supine group (1.0 [1.0, 2.0], P < 0.001). Lateral bronchial blocker placement was associated with lower incidences of postural injury (P < 0.001). The median intubation duration (single-lumen tube intubation plus bronchial blocker placement) was similar between the two groups (P = 0.089). Patients and surgeons reported higher satisfaction scores in the lateral group (P < 0.001).

Conclusions

Lateral bronchial blocker placement reduced the incidence of malposition in patients undergoing thoracic surgery; it was associated with fewer complications and higher satisfaction scores. These findings indicate that lateral placement is an effective approach with substantial advantages over conventional supine placement.

Clinial trial registration: NCT05482230.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.