非气管插管胸腔镜下肺癌手术的临床应用*

Thoracoscopelungcancer resection with non tracheal intubation anesthesia*

摘要:

目的 评估非气管插管麻醉下胸腔镜肺癌手术的可行性和安全性。方法 实验组与对照组各20 例周围型肺癌患者。实验组采用喉罩通气麻醉、对照组采用气管插管麻醉行胸腔镜下肺部手术，监测并记录 各组诱导前（T0）、诱导插管时（T1）、手术实施时（T2）和苏醒拔管时（T3）患者的收缩压（SBP）、舒张压 （DBP）、平均动脉压（MAP）、心率（HR）、心电图（ECG）、脉搏血氧饱和度（SpO2）、呼末二氧化碳分压 （PETCO2）、中心静脉压、有创动脉血压及血糖指标，并记录患者术后的相关并发症，如有无咽痛、声音嘶哑 和恶心等。结果 喉罩组患者麻醉过程中对心血管系统刺激小，术后进食、排气、下床活动时间、平均住院 日缩短，住院费用降低，咽部、呼吸及心血管系统并发症少于插管组。结论 喉罩通气静脉麻醉配合胸内迷 走神经阻滞在胸腔镜肺叶切除术中操作简易、安全性好、无插管相关并发症及单肺通气肺部损伤，符合手术 - 麻醉整体微创发展的理念，值得临床推广。

Abstract:

Objective To evaluate the feasibility and safety of thoracoscopic lung cancer surgery under nontracheal intubation anesthesia. Methods Twenty patients with peripheral lung cancer were enrolled in experimental group and control group. Then monitored and recorded Systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate (HR), electrocardiogram (ECG), heart rate (HR), Oxygen saturation (SpO2), Final moisture CO2 partial pressure (PETCO2), central venous pressure, invasive arterial blood pressure and blood glucose and the related complications like sore throat, hoarse voice, nausea and so onin such time points: before induction (T0), induction of intubation (T1), operation (T2), and sudden removal (T3) of the two groups. Results The laryngeal mask group was given a smaller stimulus to the cardiovascular system during anesthesia.The time of feeding, the exhaust, the time of getting out of bed, the average hospitalization day, the reduction of hospitalization expenses, pharynx, respiratory and cardiovascular complications were shorter and less than intubation group. Conclusion The laryngeal mask ventilation intravenous anesthesia with thoracic vagal nerve block in the thoracoscopic lobectomy is simple, safe, no intubation-related complications and single lung ventilation lung injury, in line with surgery - anesthesia overall minimally invasive development concept, worthy of clinical promotion.