非气管插管在胸外科VATS中的应用

Application of Non-intubated Anesthesia in VATS

气管插管全麻技术可提高手术安全性,因此在电视胸腔镜手术(video-assisted thoracic surgery,VATS)中得到广泛应用,但气管插管的并发症却无法避免。如何发展一种"整体微创"手术(包括麻醉微损伤),已经成为微创胸外科领域的一个研究热点。随着麻醉管理技术与对手术风险管理的进步,非气管插管技术成功应用于VATS,即采用局部麻醉以维持患者的术中自主通气,术中仅需轻微镇静或者完全清醒的状态下实施VATS,因而又称清醒状态下VATS。此麻醉方式不但减少气管插管的麻醉损伤,而且符合快速康复外科的理念。本文对非气管插管应用在胸外科VATS中的发展简史、麻醉选择、手术优势、手术风险及管理、面临的问题等方面作一综述。

Tracheal intubation general anesthesia technique is widely used in video-assisted thoracic surgery （VATS） because it can improve the safety of VATS, but the complications of tracheal intubation can not be avoided. How to develop a ＂minimally invasive＂ surgery （including micro anesthesia） has become a hot topic in the field of minimally invasive surgery. Along with the progress of the anesthesia management technology and the risk management in the operation, the technology ofnon-intubated anesthesia was successfully applied to VATS, namely using local anesthesia to maintain patients intraoperative independent ventilation and intraoperative only mild sedation or fully conscious state of implementation of thoracoscope surgery, therefore is also called awake VATS. The anesthesia method not only reduces the anesthesia injury of tracheal intubation, but also conforms to the idea of rapid rehabilitation surgery. Based on non-intubated anesthesia in VATS in the brief history of development, the anesthesia selection, operation advantages and risks are reviewed in this paper.