全胸腔镜心脏手术单腔和双腔气管插管围术期临床结果比较的回顾性队列研究  

Perioperative outcomes of single-lumen versus double-lumen endotracheal tubes in totally thoracoscopic cardiac surgery:A retrospective cohort study

作　　者：汪珍忠 肖硕 方斗 李玉欣 韦锦锋 叶颖娴 张建军 郭晓纲 曾庆诗 黄焕雷 WANG Zhenzhong;XIAO Shuo;FANG Dou;LI Yuxin;WEI Jinfeng;YE Yingxian;ZHANG Jianjun;GUO Xiaogang;ZENG Qingshi;HUANG Huanlei(School of Medicine,South China University of Technology,Guangzhou,510006,P.R.China;Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou,510080,P.R.China)

机构地区：[1]华南理工大学医学院,广州510006 [2]南方医科大学附属广东省人民医院(广东省医学科学院),广州510080

出　　处：《中国胸心血管外科临床杂志》2024年第11期1606-1612,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广州地区临床高新技术项目(2023FTJCZ0011);国家重点研发计划(2022YFC2407406)。

摘　　要：目的探究全胸腔镜心脏手术单腔气管插管双肺通气和双腔气管插管单肺通气与术后肺部并发症(postoperative pulmonary complications,PPCs)的关系。方法回顾性分析2019年10月—2021年10月于广东省人民医院接受全胸腔镜下心脏瓣膜手术患者的临床资料。按照插管方式不同,将患者分为单腔插管组和双腔插管组。对比分析两组的基线资料、手术变量以及PPCs等。通过二元logistic回归模型分析两组PPCs的影响因素。结果纳入患者349例,其中男180例、女169例,平均年龄(50.0±14.8)岁。单腔插管组219例、双腔插管组130例。两组患者术前一般资料、手术变量以及PPCs等差异均无统计学意义(P>0.05)。二元logistic回归分析显示,单腔插管组患者PPCs与术前体重指数有关[OR=0.778,95%CI(0.637,0.951),P=0.014],而双腔插管组患者PPCs与术前吸烟史有关[OR=0.058,95%CI(0.004,0.903),P=0.042]。结论对于接受全胸腔镜心脏手术的患者,单腔插管双肺通气和双腔插管单肺通气与PPCs无显著关系。同时,单腔插管组PPCs与体重指数有关,而双腔插管组PPCs与术前吸烟史有关。Objective To investigate the relationship between two-lung ventilation(TLV)with single-lumen endotracheal tube(SLT),one-lung ventilation(OLV)with double-lumen endotracheal tube(DLT)and postoperative pulmonary complications(PPCs)after total thoracoscopic cardiac surgery.Methods The clinical data of patients who underwent totally thoracoscopic cardiac surgeries in the Guangdong Provincial People’s Hospital from October 2019 to October 2021 were retrospectively analyzed.The patients were divided into 2 group according to the type of endotracheal tube,including a SLT group and a DLT group.Baseline data,surgical variables and PPCs were compared.The influencing factors of PPCs in the two groups were analyzed by binary logistic regression analysis.Results Finally 349 patients were enrolled,including 180 males and 169 females with an average age of(50.0±14.8)years.There were 219 patients in the SLT group and 130 patients in the DLT group.There was no statistical difference in baseline data,surgical variables or PPCs between the two groups(P>0.05).Binary logistic regression analysis showed that PPCs were related to body mass index in the SLT group(OR=0.778,95%CI 0.637 to 0.951,P=0.014)and preoperative smoking history in the DLT group(OR=0.058,95%CI 0.004 to 0.903,P=0.042).Conclusion For the patients who undergo totally thoracoscopic cardiac surgery,TLV with SLT and OLV with DLT show no significant association with PPCs.At the same time,PPCs are associated with body mass index in the SLT group,while associated with preoperative smoking history in the DLT group.

关 键 词：单腔气管插管 双腔气管插管 术后肺部并发症 全胸腔镜心脏手术 

分 类 号：R654.2[医药卫生—外科学]