局部麻醉自主呼吸下一期双侧胸腔镜胸交感神经夹闭术研究

The study of one stage bilateral thoracoscopic sympathetic blocking under local infiltration anesthesia

目的探讨局部麻醉自主呼吸下行一期双侧胸腔镜胸交感神经夹闭术的可行性。方法67例多汗症或颜面潮红患者自己选择麻醉方式。全麻组54例,局麻组13例。局麻组用0.5%利多卡因+0.0625%布比卡因浸润麻醉每个手术切口,术中使用瑞芬太尼辅助镇痛。每侧切2个长约7mm的皮肤切口。穿入穿刺套管,然后进行常规的胸腔镜胸交感神经夹闭术。结果所有患者均顺利完成手术。局麻组患者整个手术过程中神志清醒,完全自主呼吸。局麻组和全麻组的手术时间分别为(57±14)min和(42±12)min(P<0.01),进出手术室时间分别为(102±22)min和(106±25)min,(P>0.05),术毕至出手术室时间分别为(11±10)min和(25±11)min,(P<0.01),住院日2组分别为(3.4±0.8)d和(3.9±0.6)d(P=0.01),局麻组的手术费用少于全麻组,分别为(5388±1129)元和(6801±898)元(P<0.01)。结论一期双侧胸腔镜胸交感神经夹闭术可以在瑞芬太尼强化局部浸润麻醉下完成,手术更安全、更为微创、费用显著减少、术后恢复加快、住院日显著缩短。

Objective To detect the possibility of one stage bilateral thoracoscopic sympathetic blocking （OSBTSB） under local infiltration anesthesia and spontaneous breathing. Methods 67 patients with hyperhidrosis or facial blushing were enrolled in this study. The methods of general anesthesia （GA） or local infdtration anesthesia （LIA） were chosen by patients. There were 54 patients in group of general anesthesia （GGA） with the ages between 15 to 50 years （mean 28.81 years） and 13 in group of local infiltration anesthesia （GLIA） with the ages between 18 and 45 year （mean 26.62 years）. The LIA of each of the four incisions was made by injecting 10 ml of 1% lidocaine. OSBTSB was performed according to the routine method same as that under the GA. Results All of the operations for the 67 patients were successfully performed. All the patients in GLIA were consciousness and breathed spontaneously during the operation. The operation time was （56.92 ± 14.51 ） min for GLIA and （42.41 ± 12.16） min for GGA（ P 〈 0.01 ）. The time between entering and coming out of the operation room were （101.54 ± 22.49） min for GLIA and （106.48 ± 25.13） min for GGA（ P 〉 0.05）. The time between finishing of the operation and coming out of operation room were （ 10.77 ± 9.54） min for GLIA and （25.28 ± 11.34） min for GGA（ P 〈 0.01）. The time of hospitalization were （3.38 ± 0.77） days for GLIA and （3.89 ±0.57） days for GGA（ P = 0.01 ）. The cost were （5 388.10 ± 1 128.69） yuan for GLIA and （6 800.66± 897.88） yuanforGGA（ P 〈0.01）.Conclusion The operation of OSBTSB can be successfiflly and safely performed under LIA. All the risk of GA can be avoided if the operation performed under IJA. The superiority is much safer, more minimally invasive, cheaper, recovering faster and shorter hospitalization time comparing with those of the operations under GA.