中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

自主呼吸静脉麻醉下胸腔镜治疗纵隔肿瘤临床分析

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目的 通过对比自主呼吸静脉麻醉下胸腔镜治疗纵隔肿瘤与常规双腔气管插管静脉吸入复合麻醉胸腔镜治疗纵隔肿瘤的临床疗效,了解其安全性及可靠性。 方法 回顾性分析我院 43 例纵隔良性肿瘤患者资料,年龄 28~58 岁,术前胸部 CT 提示纵隔占位。其中 18 例患者采用自主呼吸麻醉下胸腔镜切除纵隔肿瘤,25 例患者采用常规双腔气管插管静脉吸入复合麻醉下胸腔镜切除纵隔肿瘤。比较两组患者麻醉插管时间、手术时间、手术出血量、术后 4 h 肌力、术后 24 h 肌力、术后 24 h 疼痛评分、拔管时间、住院时间。 结果 自主呼吸静脉麻醉组患者插管时间(17.8±4.8)min 较双腔气管插管静脉及吸入复合麻醉组时间(28.6±8.17)min 更短,差异有统计学意义(P<0.05)。自主呼吸静脉组术后 4 h 肌力(38.5±6.5)kg 较双腔气管静脉吸入麻醉组术后 4 h 肌力(28.3±5.2)kg 增加,差异有统计学意义(P<0.05)。而两组患者在手术时间、手术出血量、术后 24 h 疼痛评分、术后 24 h 肌力、拔管时间、住院时间比较,差异均无统计学意义(P>0.05)。 结论 自主呼吸静脉麻醉胸腔镜治疗纵隔肿瘤,其麻醉插管较常规双腔气管插管时间更短,术后麻醉复苏更快,具有一定的可行性。

Objective To evaluate the safety and the clinical curative effect of mediastinal tumor resection by video-assisted thoracoscopic surgery(VATS) with spontaneous breathing under intravenous anesthesia, comparing with endotracheal tube anesthesia. Methods The data of 43 patients, aged 28–58 years, with mediastinal benign tumors which had been cofirmed by chest CT in our hospital were retrospectively analyzed. Among them, 18 patients underwent mediastinal tumor resection by VATS with spontaneous breathing under intravenous anesthesia, 25 patients by endotracheal tube anesthesia.The differences, including the time of anesthesia intubation and extubation, operation time and intraoperative blood loss, muscle strength at 4 hours and at 24 hours after operation, pain score at 24 hours after operation, hospitalization time, were be compared between the two groups. Results The duration of intubation (17.8±4.8 min) in spontaneous breathing under intravenous anesthesia group was shorter than another group (28.6±8.17 min), the difference was statistically significant (P<0.05). Muscle strength at 4 hours after operation in spontaneous breathing under intravenous anesthesia group was significantly higher than another group (38.5±6.5 kgvs. 28.3±5.2 kg, P<0.05) as well. However, there was no significant difference between the two groups in extubation time, operation time and intraoperative blood loss, muscle strength and pain score at 24 hours after operation, hospitalization time.

关键词: 自主呼吸静脉麻醉; 胸腔镜; 纵隔肿瘤

Key words: Spontaneous intravenous anesthesia; thoracoscope; mediastinal tumor

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