Clinical Study Of 3D Reconstruction Of Chest CT Guiding Double-lumen Tube Model In Guangxi Population

Objective:General data and imaging data were retrospectively collected from patients in northern Guangxi,China,and the internal diameters of their trachea and left bronchus were measured to analyze the accuracy of predicting left double-lumen bronchial catheters according to different methods.A standardized mathematical model was also established for more accurate prediction of the size of the double-lumen bronchial tube in the southern population.Methods:Three-dimensional reconstruction of CT images of the chest was performed in 188 patients.The transverse diameter of the cricoid cartilage（TD-C）,the long diameter of the left main bronchus（LD-LMB）and the short diameter of the left main bronchus（SD-LMB）were measured.Differences between the parameters were compared using t-test or ANOVA.Generalized multiple linear regression analysis was performed to detect the correlation between each parameter and the ideal model of the left double-lumen bronchial tube（DLT）,and a multiple linear regression model was developed.Results:The mean age of male patients was 52.89±12.83 years,mean weight 67.72±13.73 kg,and mean height 167.72±6.50 cm,while the mean age of females was 50.27±13.26 years,mean weight and height 58.43±10.09 kg and157.15±5.48 cm,respectively.The differences in height and weight were statistically significant（p<0.001）when compared between genders,and there were no statistical differences in age and BMI.Male patients had TD-C measurements of 16.4±1.5 mm,TD-S measurements of 17.0±1.8 mm,and ED-LMB measurements of 13.2±1.5 mm;female patients had TD-C,TD-S,and ED-LMB measurements of 12.5±1.1 mm,14.5±1.4 mm,and 10.9±1.0 mm,respectively.TD-C values,TD-S values and ED-LMB values were significantly greater in men than in female patients（p<0.001）.TD-C was significantly and positively correlated with ED-LMB and TD-S,ED-LMB was significantly and positively correlated with TD-S,and weight and height were not significantly correlated with TD-C and ED-LMB in either male or female patients.When the accuracy of different prediction methods was analyzed with the ideal model as a reference,the accuracy of cricoid cartilage model,left main bronchus model,suprasternal fossa model and height model were 86.5%,78.7%,96.6%and 75.3%for males,respectively;the accuracy of cricoid cartilage model,suprasternal fossa model,left main bronchus model and height model were 73.7%,10.1%,55.6%and 20.2%for females,respectively.55.6%and 20.2%,respectively.The two formulas to establish the predicted intubation model are:Equation 1:=2.432×+0.243×+0.61×+0.499×+16.911Formula 2:=3.956×+0.349×+0.698×+21.009Y is the predicted value of left DLT,X₁ is the gender（male takes the value of1 and female takes the value of 0）,X₂ is the LD-LMB value,X₃ is the SD-LMB value,and X₄ is the TD-C value.Conclusions:The mean height and weight and tracheal internal diameter of patients in the south were significantly smaller than those in the north.The mean height,weight,left main bronchial equivalent internal diameter and cricoid cartilage diameter were significantly larger in men than in women in the south.The cricoid cartilage and left main bronchial equivalent internal diameter could not be accurately predicted based on height and weight.The left main bronchial equivalent internal diameter correlated significantly with the cricoid cartilage transverse diameter,with a ratio of 80.4%in men and 87.2%in women,so the cricoid cartilage transverse diameter best determined the left main bronchial equivalent internal diameter.In male patients,it is more accurate to predict the type of left DLT based on height,cricoid cartilage transverse diameter or left main bronchial equivalent internal diameter.In female patients,the type of the left DLT is recommended to be determined by both the cricoid cartilage and the equivalent internal diameter of the left main bronchus.Two formulas were established for reference,and their accuracy needs to be validated by further prospective studies.