中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

非气管插管麻醉在胸腔镜肺叶切除术中的应用对比研究

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目的 通过对比研究分析非气管插管麻醉在胸腔镜肺叶切除术中应用的可行性与优势。 方法 回顾性分析 2015 年 1 月至 2017 年 12 月武汉同济医院胸外科非气管插管胸腔镜肺叶切除术患者 59 例(观察组)的临床资料,其中男 24 例、女 35 例,年龄(56.86±7.13)岁。另随机抽取同期行气管插管全身麻醉胸腔镜肺叶切除术患者 59 例,作为对照组,其中男 27 例、女 32 例,年龄(55.37±6.86)岁。比较两组病例在气道损伤、顽固性干咳、咽痛、恶心呕吐等并发症发生率、术后炎性因子水平、术后留置胸腔引流管时间、术后住院时间、手术+术后总费用等指标方面差异。 结果 两组患者在年龄、性别等一般情况并无差异。手术时间、术中失血量、淋巴结清扫效果并无差异。但观察组术后第 1 d 降钙素原,术后第 1 d C 反应蛋白较对照组低[(0.12±0.51)ng/ml vs.(0.14±0.70)ng/ml,P=0.03;(11.30±3.60)mg/L vs.(13.33±4.41)mg/L,P=0.01];术后顽固性干咳发生率、咽痛发生率、恶心呕吐发生率较对照组低(3.38% vs. 15.25%,P=0.03;5.08% vs. 20.33%P=0.01;3.38% vs. 15.25%,P=0.03);术后留置胸腔引流管时间、术后住院时间、手术+术后总费用等方面较对照组均具有明显优势[(5.89±1.37)d vs.(7.00±1.73)d,P=0.00;(10.01±1.85)d vs.(11.37±2.45)d,P=0.00;(53 810.94±5 745.44)元 vs.(58 223.16±6 445.08)元,P=0.00]。 结论 非气管插管麻醉应用于胸腔镜肺叶切除术可避免传统气管插管所致气道损伤,减少声音嘶哑、咽痛、恶心呕吐等全身麻醉所致症状,减少甚至避免单肺机械通气所造成肺损伤,促进术后快速康复,缩短住院时间,更符合整体微创及快速康复的理念要求。

Objective To analyze the feasibility and advantages of non-intubated anesthesia in thoracoscopic lobectomy. Methods The clinical data of 59 patients with thoracoscopic lobectomy and non-intubated anesthesia in the Department of Thoracic Surgery, Tongji Hospital from January 2015 to December 2017 were retrospectively reviewed, including 24 males and 35 females, aged 56.86±7.13 years (an observation group); 59 patients with thoracoscopic lobectomy undergoing general anesthesia with tracheal intubation in the same period were randomly selected, as a control group, including 27 males and 32 females, aged 55.37±6.86 years. Complications such as airway injury, refractory cough, pharyngalgia, nausea and vomiting were compared between the two groups. Postoperative inflammatory factor levels, postoperative hospital stay, and intraoperative and postoperative hospitalization costs were also compared. Results There was no difference between the two groups in general conditions such as age, gender, body mass index. There was also no difference in operation time, intraoperative bleeding volume or lymph node dissection. But the observation group had lower levels of procalcitonin and C reactive protein at postoperative 1 d (0.12±0.51 ng/ml vs. 0.14±0.70 ng/ml, P=0.03; 11.30±3.60 mg/L vs. 13.33±4.41 mg/L, P=0.01), lower rate of postoperative complications of refractory cough, pharyngalgia, nausea and vomiting (3.38% vs. 15.25%, P=0.03; 5.08% vs. 20.33%, P=0.01; 3.38% vs. 15.25%, P=0.03), less retain time of thoracic duct, postoperative hospital stay, and lower intraoperative and postoperative hospitalization costs (5.89±1.37 d vs. 7.00±1.73 d, P=0.00; 10.01±1.85 d vs. 11.37±2.45 d, P=0.00; 53 810.94±5 745.44 yuan vs. 58 223.16±6 445.08 yuan, P=0.00). Conclusion Thoracoscopic lobectomy with non-intubated anesthesia can avoid traditional airway injury caused by endotracheal intubation, reduce postoperative symptoms such as refractory cough, pharyngalgia, nausea and vomiting caused by general anesthesia, reduce or even avoid lung injury caused by one-side lung ventilation, promote recovery after surgery, reduce antibiotic use, and shorten hospital stay, which is more consistent with the requirements of the concept of overall minimal invasiveness and enhanced recovery.

关键词: 非气管插管; 胸腔镜; 肺叶切除术

Key words: Non-intubation; thoracoscope; lobectomy

引用本文: 尹随, 李樊, 邓豫, 祖育昆, 许巧巧, 张毅, 赵波. 非气管插管麻醉在胸腔镜肺叶切除术中的应用对比研究. 中国胸心血管外科临床杂志, 2019, 26(1): 57-62. doi: 10.7507/1007-4848.201804018 复制

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1. Klijian AS, Gibbs M, Andonian NT. AVATS: Awake Video Assisted Thoracic Surgery--extended series report. J Cardiothorac Surg, 2014, 9: 149.
2. Hung MH, Chan KC, Liu YJ, et al. Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade: a retrospective cohort study of 238 cases. Medicine (Baltimore), 2015, 94(13): e727.
3. Tacconi F, Pompeo E. Non-intubated video-assisted thoracic surgery: where does evidence stand? J Thorac Dis, 2016, 8(Suppl 4): S364-S375.
4. 陈万青, 孙可欣, 郑荣寿, 等. 2014 年中国分地区恶性肿瘤发病和死亡分析. 中国肿瘤, 2018, 27(1): 1-14.
5. 丁宁宁, 毛友生. 早期非小细胞肺癌淋巴结转移规律与清扫方式研究进展. 中国肺癌杂志, 2016, 19(6): 359-363.
6. 张文雄, 喻东亮, 江涵, 等. 电视胸腔镜手术与开胸手术在肺癌淋巴结清扫中效果比较的系统评价和 Meta 分析. 中国胸心血管外科临床杂志, 2016, 23(10): 992-1000.
7. 代小探, 宋平平, 张百江. 非气管插管在胸外科 VATS 中的应用. 中国肺癌杂志, 2016, 19(5): 312-316.
8. 蒋波, 沈江, 俞鹏翼, 等. 免气管插管和传统双腔插管微创肺叶切除术的早期疗效对比. 肿瘤防治研究, 2017, 44(10): 686-688.
9. Bhaskaran P, Katsipoulakis A, Caliandro F, et al. Video-assisted thoracoscopic surgery under non-intubated spontaneous breathing anesthesia using laryngeal mask. J Cardiothorac Surg, 2015, 10(Suppl 1): A272.
10. Wang ML, Galvez C, Chen JS, et al. Non-intubated single-incision video-assisted thoracic surgery: a two-center cohort of 188 patients. J Thorac Dis, 2017, 9(8): 2587-2598.
11. 孙正清, 盖成林, 苏芳, 等. 全身麻醉气管插管并发关节脱位临床分析. 临床误诊误治, 2016, 29(3): 76-78.
12. 金成林. 乳腺癌手术中使用喉罩与气管插管时对咽喉与血压的影响比较. 中国现代药物应用, 2017, 11(6): 130-131.
13. 周斌, 赵建生, 徐德才. 左双腔管置管致左支气管破裂一例. 临床麻醉学杂志, 2004, 20(6): 345.
14. Suryadevara V, Fu P, Ebenezer DL, et al. Sphingolipids in ventilator induced lung injury: role of sphingosine-1-phosphate lyase. Int J Mol Sci, 2018, 19(1): pii: E114.
15. Wang T, Gross C, Desai AA, et al. Endothelial cell signaling and ventilator-induced lung injury: molecular mechanisms, genomic analyses, and therapeutic targets. Am J Physiol Lung Cell Mol Physiol, 2017, 312(4): L452-L476.
16. 李受南. 胸外科手术患者急性肺损伤的发生及预防进展. 中国现代医生, 2014, 52(33): 152-154.
17. 罗科, 徐军美, 高巨. 机械通气肺生物性损伤机制及防治. 临床麻醉学杂志, 2016, 32(5): 514-517.
18. 严蕾, 陈玉培. 麻醉药物对肿瘤微转移影响及机制的研究进展. 医学研究生学报, 2016, 29(7): 780-784.
19. 闫红珊, 张欢, 杨拔贤. 残余肌松对全身麻醉患者术后拔管早期呼吸功能的影响. 临床麻醉学杂志, 2010, 26(11): 941-943.
20. 许建能, 谢可, 钟军. 插管型喉罩和气管插管用于妇科腹腔镜手术麻醉的效果对比. 医学理论与实践, 2018, 31(2): 240-242.
21. 郑威, 黄杰. 胸腔镜肺叶切除术对非小细胞肺癌患者炎性因子及免疫功能的影响. 实用癌症杂志, 2017, 32(2): 295-298.