气管超声结合临床参数选择左双腔导管大小:前瞻性观察研究
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Use of tracheal ultrasound combined with clinical parameters to select left double-lumen tube size ：A prospective observational study
背景与目的
左双腔管（LDLTs）用于胸外科（胸部）手术来实现单肺通气。双腔支气管导管的尺寸通常是根据临床参数（身高、性别）来进行选择，因此时常出现尺寸过小或过大的情况，可能发生导管移位或气管损伤等风险。有研究证实超声检测气管直径与左侧主支气管直径相关。因此我们假设当使用常规临床（普通）标准选择双腔支气管导管时，发生插入导管尺寸过小/过大的频率较高，而使用超声评估气管直径可有助于减少插入过大导管的频率，并进行了一项前瞻性观察研究来验证这一假设。
方 法
收集2016年1月至2017年2月法国某大学医院手术室择期行胸外科手术的患者，其中常规临床标准组102名，超声组50名（男性占比63.7% vs 60.0%，年龄63[13]岁vs 63[11]岁，身高170[13]cm vs 169[9]cm）。常规临床标准组根据临床参数选择插入LDLT的尺寸。收集气管直径的超声数据以确定身高与气管直径相关的分界点，回顾性分析超声气管直径的分界值，并验证这些分界值是否有利于降低过大导管的插入频率。超声组则根据确定的组合分界值选择LDLT尺寸。主要观察指标——如果隔离肺所需的支气管导管气囊注气量（即吸气和呼气时肺容积无差异）为0.5~2.5mL空气，则认为LDLT大小合适；尺寸过小和尺寸过大的导管分别需要2.5mL以上和0.5mL以下的注气量。
结 果
常规临床标准组中40例（39.2%）患者LDLT大小合适、23例（22.6%）LDLT过小、39例（38.6%）LDLT过大。超声测量的分界值可使过大导管使用频率减少20.6%(P < 0.001)。超声组中使用适当尺寸导管的频率增加（86.0 vs.39.2%，P<0.001），而插入过大和过小导管的频率减少（6.0 vs.38.2%，8.0 vs.22.6%，P<0.001）。
结 论
超声测量气管直径与临床参数相结合可改进LDLT尺寸的选择。
原始文献摘要
Roldi E, Inghileri P, Dransart-Raye O, et al.Emanuela Roldi, Paolo Inghileri, Ophelie Dransart-Raye, et，al.Use of tracheal ultrasound combined with clinical parameters to select left double-lumen tube size ：A prospective observational study.[J].Eur J Anaesthesiol. 2019 ,36(3):215-220.
BACKGROUND Left double-lumen tubes (LDLTs) are used in thoracic surgery to allow one-lung ventilation. Their size is usually chosen on the basis of clinical parameters (height,sex). Double-lumen endobronchial tubes are frequently undersized/oversized, risking tube displacement or tracheal trauma. A correlation between ultrasound tracheal diameter and left main bronchus dimension has been demonstrated.
OBJECTIVES We hypothesised that the insertion of undersized/oversized double-lumen tubes is frequent when the size is selected using standard criteria, and that the use of ultrasound to estimate tracheal diameter may help to reduce the frequency of insertion of oversized tubes.
DESIGN Two-step prospective observational study.
SETTING The operating room of a French University hospital from January 2016 to February 2017.
PATIENTS We enrolled 102 and 50 consecutive patients undergoing elective thoracic surgery in Steps 1 and 2 (males 63.7 and 60.0%, age 63 (13) and 63 (11) years,height 170 (13) and 169 (9) cm, respectively).
INTERVENTION In Step 1, the size of the LDLT inserted was selected on the basis of clinical parameters. Ultrasound data about tracheal diameter were collected to determine cut-off points associating height and tracheal diameter. Cut-off values for ultrasound tracheal diameter were applied retrospectively to test their capability to reduce the insertion rate of oversized tube. In Step 2, the LDLT size was chosen according to the determined combined cut-off values.
MAIN OUTCOME MEASURE LDLT size was considered adequate if the bronchial cuff volume required for isolation of the lung (i.e. no difference between inspiratory and expiratory lung volumes) was 0.5 to 2.5 ml of air; undersized and oversized tubes required more than 2.5 ml and less than 0.5 ml, respectively.
RESULTS In Step 1, LDLT size was appropriate/undersized/oversized in 40 (39.2%)/23 (22.6%)/39 (38.6%) of patients.Cut-off values derived from ultrasound measurements would have reduced the use of oversized tubes by 20.6% (P < 0.001). In Step 2, the frequency of use of adequately sized tubes increased (86.0 vs. 39.2%, P < 0.001), and the frequency of insertion of oversized and undersized tubes decreased (6.0 vs. 38.2% and 8.0 vs. 22.6%, both P < 0.001).
CONCLUSION Combining ultrasound measurement of tracheal diameter and clinical parameters improves the choice of LDLT size.
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翻译：牛振瑛 编辑：冯玉蓉 审校：王贵龙