| Objective:The accurate positioning of the double-lumen bronchial tube is essential for effective air exchange during single-lung ventilation,and because of the right upper lobe bronchus opening is very close to the trachea,the safe range of the correct position of R-DLT is small,and it is easy to block the right upper lobe bronchus opening.In addition,there are many anatomical variations of the right upper lobe bronchial opening,so the right double lumen is more difficult to align than the left.Therefore,it is particularly important to accurately grasp the anatomical structure of the trachea and main bronchus.Preoperative CT examination can provide clear data on the local structure of the airway,effectively predict the difficulty of positioning the double-lumen tube due to the patient’s own reasons and provide guidance for intraoperative airway management.The effective method is also of great significance to realize the individualized selection of the double-lumen tube,reduce the occurrence of complications,and ensure the function of ventilation.This article aims to combine patients with preoperative chest CT imaging data to guide and explore the selection of a suitable right double-lumen endotracheal intubation model.Method:122 patients with left lung cancer who underwent left total lung or upper left lobectomy,aged 40 to 60 years old,underwent chest CT plain scan one day before the operation.After three-dimensional reconstruction of chest CT of all patients,sex,BMI,and age were recorded,course of disease,operation method,right upper lobe bronchus opening main bronchus angle,right upper lobe bronchus opening and bulge distance,right main bronchus diameter and other data,through Logistic regression analysis model,whether the failure of one-time intubation as the dependent variable,Gender,BMI,age,course of disease,surgical method,distance between upper right lobe bronchus opening and carina,right upper lobe bronchus opening main bronchus angle,the right main bronchus diameter is used as the independent variable to obtain the estimated value of the regression coefficient after logistic regression,and filter out the influencing factors that are meaningful for the positioning of the double lumen,Draw the ROC curve separately,and predict the influencing factors that affect the right double-lumen intubation and the critical value according to the area under the curve and the Yoden index of the ROC curve.Result:(1)The distance between the bronchus opening of the upper lobe of the right lung and the bulge predicts the ROC curve and the area under the ROC curve of the failed intubation registration,and AUC = 0.9160(95% CI,0.8650-0.9671;P <0.0001),Youden index.The maximum value is 0.6635,and the sensitivity and specificity at this time are 84.21% and 82.14% respectively,corresponding to the optimal critical value of <15.95 mm.It indicates that the probability of predicting the failure of a single intubation alignment is 82.41% when the distance between the bronchus opening of the right upper lobe and the carina is less than 15.95 mm.(2)The right lung upper lobe opening angle A predicts the ROC curve and the area under the curve of one-time intubation failure,and obtains AUC = lower area of 0.8264(95% CI,0.7532-0.8997;P <0.0001),with the largest Youden index.The value is 0.6065.At this time,the sensitivity and specificity are 86.84% and 73.81% respectively,corresponding to the best critical value is greater than 100.7,indicating that the right upper lobe bronchus opening and the main bronchus angle is greater than 100.7 ° predicted one-time intubation alignment.The probability of failure is 73.81%.(3)The right main bronchus diameter predicts the ROC curve and the curve under the one-time intubation failure,and AUC=0.7914(95% CI,0.7002-0.8825;P <0.0001),the maximum value of the Youden index is 0.5106,and the sensitivity The specificity is 73.68% and 77.38% respectively,corresponding to the optimal critical value <13.65 mm,indicating that the probability of predicting the failure of disposable intubation alignment when the diameter of the right main bronchus is less than 13.65 mm is 77.38%.(4)The Z test is used to compare the three indexes AUC.The AUC of the distance between the upper lung lobe tracheal opening and the bulge is higher than that of the other two groups,and it is statistically significant(0.9160 VS 0.7914,Z = 2.336,P = 0.019;0.9160 VS 0.8264,Z = 1.966,P = 0.025).There was no significant difference in AUC between the diameter of the right main bronchus and the angle of the main bronchial opening of the right upper bronchus(0.7914 VS 0.8264,Z = 0.586,P=0.558).It shows that among the above three related factors that affect the failure of intubation alignment,the effect of the variable of the distance between the opening of the right upper lobe and the carina is particularly obvious.Conclusion:Before operation,chest CT can simply predict the possibility of successful alignment of the right double-lumen tube.(1)It can understand the airway patency,whether it is combined with lumen stenosis,distortion or even deformity.(2)The position of trachea bulge can be clarified and its deviation can be assessed.(3)Observe the opening position of the right upper lobe and the right main bronchus,measure the distance between it and the carina,the angle between the right upper lobe and the main airway,and the diameter of the right main bronchus.(4)It can realize the individualized formulation of anesthesia program to reduce the repeated intubation caused by the anatomical structure variation of some patients,resulting in secondary intubation injury and other iatrogenic injuries. |
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