喉罩全麻和气管插管全麻在单孔胸腔镜肺叶切除术中的临床对照研究

Comparison of laryngeal mask anesthesia and intubation anesthesia under spontaneous ventilation in uniportal video-assisted thoracoscopic surgery

目的:评估保留自主呼吸的喉罩全麻在单孔胸腔镜下肺叶切除术中应用的可行性。方法:喉罩组与双腔支气管组各20例肺占位行胸腔镜肺叶切除术淋巴结清扫术患者。两组均行肋间神经阻滞,术中喉罩组不使用肌松药,保留自主呼吸;双腔管组使用肌松药,术中行单肺通气。结果:喉罩组与双腔管组在手术时间、术中最低SpO_2、术前、术后1 h PaCO_2无明显差异。喉罩/双腔管放置满意用时、拔管时间、恢复室停留时间、术后住院时间喉罩组均短于双腔管组。插喉罩/双腔管前后,△MAP、△HR喉罩组低于双腔管组。术中每千克体重舒芬太尼、丙泊酚用量喉罩组显著少于双腔管组。肺叶切除后血气PaCO_2、术中最高PETCO_2,喉罩组显著高于双腔管组。术后咽喉痛发生率、住院总费用喉罩组低于双腔管组。结论:保留自主呼吸的喉罩全麻用于胸腔镜肺叶切除术具有明显优势。

Objective To assess the feasibility of laryngeal mask anesthesia under spontaneous ventilation in pulmonary resection with uniportal video- assisted thoracoseopie. Methods Forty patients with pulmonary masses were randomized into two groups（n = 20 in each group） to undergo pulmonary resection with uniportal video- assisted thoracoscopic, full implementation of thoracoscopic lobectomy and mediastinal lymph node dissection. Patients in two groups were induced by intravenous anesthesia, and the skin of the fifth intercostal space were infiltrated with ropivacaine. Patients in two both groups were maintained by intravenous anesthesia and sevoflurane anesthesia. Muscle relaxants were administered in endotracheal intubation group but not in the LMA group. Patients in the LMA group and tracheal intubation group underwent with spontaneous breathing and one-lung ventilation respectively. Results No significant differences were found in surgery time, intraoperative lowest SpO2, preoperative PaCO2,1-h postoperative blood gas analysis between the two groups. The anesthesia induction time, extubation time, and the stay time for the recovery of anesthesia and postoperative hospital stay were significantly shorter than those in the tracheal intubation group. The increments in MAP and HR after intubation operation were smaller than those in the LMA group. The total dosage of sulfentanyl and propofol per kg in the LMA group were significantly less than those in the control group. The PaCO2 after pulmonary resection and the intraoperative maximum level of PETCO2 in the former group were significantly higher than those in the tracheal intubation group, however the incidence of throat discomfort and the hospitalization cast were significantly decreased. Conclusion In view of patient rehabili- tation and in hospitalization cast, laryngeal mask anesthesia under spontaneous ventilation in uniportal video-assisted thoracoscopie surgery was better than the procedure performed under intubation anesthesia.