插管与非插管麻醉在单孔胸腔镜下行胸交感神经节切断术的效果

摘要

Objective To investigate the efficacy of intubated and non-intubated anesthesia in uniportal thoracoscopic surgery for thoracosympathectomy.Methods Sixty palmar hyperhidrosis patients undergoing thoracosympathectomy were divided into two groups randomly(n =30 in each group):non-intubated anesthesia group and double lumen intubated general anesthesia group.The patients in nonintubated anesthesia group underwent insertion of an epidural catheter at the T4-5 thoracic interspace to maintain a sensory block and thoracoscopic vagal nerve block,and the patients in double lumen intubated general anesthesia group underwent left double lumen intubated general anesthesia.SBP,DBP,HR,SpO2,RR,SpO2,PETCO2,exposure of surgical field,anesthetic effect,anesthesia duration,operfative time,postoperative complications,postoperative nursing call,anesthetic cost,postoperative food uptake time,postoperative ambulation,hospitalization time,degree of patient satisfaction were recorded before anesthesia(T0),5 min after opening right chest(T1),before right lung inflation(T2),5 min after closing right chest (T3),5 min after open left chest (T4),before left lung inflation (T5),5 min after close left chest(T6),returning ward(T7).Results All operations were completed successfully.SBP,DBP,HR kept in the normal range during operation.SpO2 decreased at T1-T5,and the minimum value was 91％.PETCO2 increased at T2,T5,and the maximum value was 65 mmHg.There was no significant difference between two groups in anesthetic effect,surgical field quality,operative time,and incidence of pneumothorax.Compared with double lumen intubated general anesthesia group,the anesthetic duration,postoperative nursing call,postoperative food uptake time,postoperative ambulation,hospitalization time,postoperative complications were shortened in non-intubated anesthesia group(P ＜ 0.05).The degree of patient satisfaction in non-intubated anesthesia group was better than in double lumen intubated general anesthesia group(P ＜ 0.05).Conclusion The non-intubated anesthesia in uniportal thoracoscopic surgery for thoracosympathectomy has the advantages of less complication,rapid recovery and lower expense,but it is necessary to choose the patient strictly and prepare the emergency plan before operation for ensuring the safety.%目的 比较插管和非插管两种麻醉方法在单孔胸腔镜下行胸交感神经链切断术的效果. 方法 60例在电视胸腔镜下行双侧交感神经干切断术的手汗症患者,按随机数字表法分为非气管插管组和气管插管组,每组30例.非气管插管组采用T4-5硬膜外阻滞复合胸内迷走神经阻滞,气管插管组采用左侧双腔气管插管全身麻醉.分别于麻醉前(T0)、右侧胸腔开放后5 min(T1)、右侧膨肺前(T2)、右侧胸腔关闭后5 min(T3)、左侧胸腔开放后5 min(T4)、左侧膨肺前(T5)、左侧胸腔关闭后5min(T6)、返回病房(T7),分别记录患者SBP、DBP、HR、RR、SpO2、PETCO2及术中视野暴露情况、麻醉效果、麻醉时间、手术时间、术后相关并发症、术后护理强度、麻醉费用、术后开始进食时间、术后开始下地活动时间、住院时间和患者满意度. 结果 所有手术均顺利完成,没有中转开胸情况发生.围术期两组患者SBP、DBP、HR均在正常范围内,非插管组患者氧饱和度在在T1-T5时点较术前下降,最低值91％,呼吸末二氧化碳在T2、T5时点较术前升高,最高值65 mmHg,高于插管组患者(P＜0.05),术中未给予特殊处理.两组术中视野暴露情况、麻醉效果评分、手术时间、术后气胸发生率差异无显著性(P＞0.05),非插管组麻醉时间、术后护理强度、术后开始进食、下地活动时间、住院时间、术后咽喉不适、恶心呕吐情况低于插管组(P＜0.05).非插管组患者的满意度评分高于插管组(P＜0.05). 结论 应用非插管麻醉方式在单孔胸腔镜下胸交感神经干切断术中,具有术后并发症少、恢复快和花费少的优势,但是需要严格把握适应证,术前做好应急预案,保证患者安全.