胸腔镜手术中使用ProSeal喉罩联合支气管阻塞器与使用双腔支气管导管的比较：一项随机对照试验

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胸腔镜手术中使用ProSeal喉罩联合支气管阻塞器与使用双腔支气管导管的比较：一项随机对照试验

贵州医科大学    麻醉与心脏电生理课题组

翻译：潘志军   编辑：柏雪   审校：曹莹

研究目的：使用ProSeal喉罩联合支气管阻塞器可能减少术后声音嘶哑和咽喉痛。我们旨在测试这种组合技术在胸腔镜手术中的可行性和有效性。   

设计：单中心、患者-评估者盲法、随机对照试验。

地点：名古屋市立大学医院（2020年11月至2022年4月期间）。

患者：共100例接受视频或机器人辅助胸腔镜肺叶切除或肺段切除的成年患者。  

干预：患者随机分配到使用ProSeal喉罩联合支气管阻塞器组合（pLMA+BB组）或双腔支气管导管（DLT组）。  

测量：主要结局是术后1-3天的声音嘶哑发生率。次要结局包括咽喉痛、术中并发症（低氧血症、高碳酸血症、手术中断、置入物位置不良、意外肺扩张和通气困难）、肺萎陷、置入物相关结果和苏醒期咳嗽。    

主要结果：共有100例患者进行了随机分配（51例分配到pLMA+BB组，49例分配到DLT组）。剔除退出者后，每组49例患者按方案进行了分析。pLMA+BB组和DLT组的声音嘶哑发生率在术后第1、2和3天分别为42.9%和53.1%（差异，-10.2%；95%置信区间，-30.1%至10.3%；p=0.419）、18.4% vs 32.7%和20.4% vs 24.5%。在术后第1天pLMA+BB组和DLT组的咽喉痛发生率分别为16.3% vs 34.7%（差异，-18.4%；95%置信区间，-35.9%至-0.9%；p=0.063）。与DLT组相比，pLMA+BB组出现了更多的术中并发症和较少的苏醒期咳嗽。两组之间的肺萎陷和置入物相关结果无差异。  

结论：ProSeal喉罩联合支气管阻塞器与双腔支气管导管相比，没有显著减少声音嘶哑。

原始文献来源：Toshiyuki Nakanishi, Yoshiki Sento, Yuji Kamimura,et al.Combined use of the ProSeal laryngeal mask airway and a bronchial blocker vs. a double-lumen endobronchial tube in thoracoscopic surgery: A randomized controlled trial [J]. (J Clin Anesth. 2023 Sep;88:111136).      

英文原文：

Combined use of the ProSeal laryngeal mask airway and a bronchial blocker vs. a double-lumen endobronchial tube in thoracoscopic surgery: A randomized controlled trial        

Study objective: The combined use of the ProSeal laryngeal mask airway and a bronchial blocker may reduce postoperative hoarseness and sore throat. We aimed to test the feasibility and efficacy of this combination technique in thoracoscopic surgery.

Design: A single-center, patient-assessor blinded, randomized controlled trial.

Setting: Nagoya City University Hospital (between November 2020 and April 2022).

Patients: A total of 100 adult patients undergoing lobectomy or segmentectomy by video- or robotic-assisted thoracoscopic surgery.

Interventions: Patients were randomly assigned to either group using a combination of the ProSeal laryngeal mask airway and a bronchial blocker (pLMA+BB group) or a double-lumen endobronchial tube (DLT group).

Measurements: The primary outcome was the hoarseness incidence on 1-3 postoperative days. Secondary outcomes included sore throat, intraoperative complications (hypoxemia, hypercapnia, surgical interruption, malposition of devices, unintended lung expansion, and ventilatory difficulty), lung collapse, device placementrelated outcomes, and coughing during emergence.

Main results: A total of 100 patients underwent randomization (51 to the pLMA+BB group and 49 to the DLT group). After drop outs, a total of 49 patients in each group were analyzed per-protocol. The incidences of hoarseness in the pLMA+BB and DLT groups were 42.9% and 53.1% (difference, -10.2%; 95% confidence interval, -30.1% to 10.3%; p = 0.419), 18.4% vs. 32.7%, and 20.4% vs. 24.5% on postoperative day 1, 2, and 3, respectively. The incidences of sore throat in the pLMA+BB and DLT groups were 16.3% vs. 34.7% (difference, -18.4%; 95% confidence interval,-35.9% to -0.9%; p = 0.063) on postoperative day 1. In the pLMA+BB group, more intraoperative complications and less coughing during emergence were observed compared to the DLT group. Lung collapse and placement-related outcomes were comparable between the groups.

Conclusions: The combination of ProSeal laryngeal mask airway and bronchial blocker did not significantly reduce hoarseness compared to the double-lumen endobronchial tube.

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文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：Michel.米萱

校对：MiLu.米鹭  

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