| Objective:As one of the tools to achieve lung isolation technology,the double-lumen endobronchial tube is often used in thoracic surgery.The purpose is to protect the healthy side of the lung,while at the same time making the lung collapse,providing a satisfactory field of vision for the surgeon and facilitating surgical operation.The accuracy of double-lumen endobronchial tube localization is critical to the successful implementation of lung isolation techniques,and the accuracy of predicting the depth of intubation using height,sex,body surface markers,etc.is not high at this stage.At present,as the most sensitive and spatially high-resolution imaging tool for lung imaging,high-resolution computed tomography（HRCT）has been widely used in preoperative examination of thoracic patients.The purpose of this article is to explore the accuracy of improving the depth of binocular intubation by reading HRCT in patients and locating the depth of binal endotracheal catheterization,comparing its accuracy with that of predicting the depth of intubation by height.Methods:From May 2021 to August 2021,120 adult patients who underwent thoracic surgery at the Second Hospital of Jilin University were selected,including 70 patients with left-side double-lumen tube insertion and 50 patients with right-side double-lumen tube insertion,aged 18-75 years old,ASA classification I-III.Before surgery,Neu Sight Medicine Imaging Platform was used to read all patients’ HRCT,measuring the thoraciclavicular joint level transverse tracheal diameter（Tr-TD）and the distance from the glottis to the carina of trachea（G-TL）,select the appropriate double-lumen tube according to the Tr-TD.The correlation between G-TL and height,weight,age,and gender was explored.According to the computer-generated random number method,patients with left-side double-lumen tube were divided into LCT groups（group with HRCT to measuring the distance from the glottis to the carina of trachea predicted depth of intubation）and LCI group（group using height to predict depth of intubation）,with 35 patients in each group.Patients with the right-side double-lumen tube were divided into the RCT group（group with HRCT to measuring the distance from the glottis to the carina of trachea predicted depth of intubation）and the RCI group（group using height to predict the depth of intubation）,each group of 25 patients.The patient’s general condition,the position of the first intubation,the timing of catheter positioning,the postoperative bleeding of the mucous membrane in each segment of the trachea,the hoarseness and sore throat of the patient 6 hours after the operation were recorded,and the results were statistically analyzed.Results:（1）Between the LCT and LCI groups,RCT and RCI groups,the age,sex,height,weight,and ASA classification of patients were not statistically significant（P>0.05）.（2）There is a strong positive correlation between height and G-TL;there is a moderate negative correlation between sex and G-TL,which is due to the fact that in statistical analysis,males are marked as "1" and females are marked as "2",and the results are negatively correlated,that is,the larger the number,the shorter the G-TL,and the shorter the female G-TL;the weight and age are weakly positively correlated with G-TL.（3）26 of the 35 patients in the LCT group were in the correct position with fiber bronchoscopy after intubation,and the success rate was 74.3%,13 cases in the LCI group were in the correct position,the success rate was37.1%;there were 6 cases of shallow misalignment and 2 cases of deep misalignment in the LCT group,and 1 case was excluded from the statistical analysis due to intubation of the direction of the catheter（the left-side double-lumen tube entered the right bronchial）,and the experimental data related to intubation were excluded in the statistical analysis;12 cases of shallow misalignment and 7 cases of deep misalignment in the LCI group.3cases of severe shallow misalignment.The two groups of data were tested by non-parametric Mann-Whitney U,and the P-value was 0.002（P<0.05）,indicating that the difference between the two groups was statistically significant.Among the 25 patients in the RCT group,18 patients were in the correct position with fiber bronchoscopy after intubation,with a success rate of 72.0%,10 cases in the RCI group were in the correct position,with a success rate of 40.0%;4 cases in the RCT group were shallow misalignment and 3 cases were deep misalignment;7 cases in the RCI group were shallow misalignment,4 cases were deep misalignment,3 cases were severe deep misalignment,and 1 case was intubated in the direction of the catheter（the right-side double-lumen tube entered the left bronchial）,and the experimental data related to the intubation were excluded in the statistical analysis.The non-parametric Mann-Whitney U test was used to obtain a P-value of 0.027（P<0.05）,indicating that the difference between the two groups was statistically significant.（4）The fiber bronchoscopy and correction positioning time of the LCT group was 18.4±5.7s,the fiber bronchoscopy and corrected positioning time of the LCI group was 29.8±13.2s,and the difference between the two groups was statistically significant（p<0.01）;the fiber bronchoscopy and corrected positioning time of the RCT group was 22.5 ± 7.1s,and the fiber bronchoscopy and corrected positioning time of the RCI group was 39.7 ±19.5s,and the difference between the two groups was statistically significant（p<0.01）.（5）Intergroup airway injury and hoarseness and sore throat were not statistically significant（p>0.05）.Conclusion:（1）Glottis-carina distance（G-TL）has a strong positive correlation with height,and a moderately strong correlation with gender.Male G-TL is generally larger than female G-TL,and there is a weak positive correlation with weight and age.（2）Preoperative prediction of double-lumen endotracheal intubation depth using chest HRCT is more accurate and effective than using height to predict intubation depth.It is a new method worth promoting. |
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