非气管插管麻醉对加速康复外科理念在原发性手汗症患者手术治疗中的体现

Non-intubated anesthesia as a practice of enhanced recovery after surgery in endoscopic thoracic sympathectomy for primary hyperhidrosis

目的探讨非气管插管麻醉(NIA)在原发性手汗症(PH)患者腔镜下胸交感神经链切断术(ETS)中的应用特点,促进加速康复外科(ERAS)理念在PH手术治疗中的应用。方法回顾性分析行ETS的37例PH患者的临床资料,根据麻醉插管方式分为非气管插管组(n=12)和气管插管组(n=25)。患者均先行右侧交感神经切断,术中行常规监测和双手掌温监测,记录两组患者麻醉前(t1)、切断右侧胸交感神经时(t2)、切断左侧胸交感神经时(t3)和术毕清醒时(t4)不同时点的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO2),并比较两组患者的麻醉时间、手术时间、术后住院天数、术后次日晨疼痛评分、术后并发症发生率及住院总费用。结果两组患者同一时点的MAP、HR和SpO2比较,差异均无统计学意义(P>0.05);两组患者手术时间比较,差异也无统计学意义(P>0.05);两组患者交感神经切断后同侧掌温平均升高(2.2±0.6)℃。非气管插管组患者麻醉时间、术后住院天数、术后第1天疼痛评分、拔管后并发症发生率及住院总费用均明显低于气管插管组,差异有统计学意义(P<0.05)。结论NIA在ETS中的应用具有损伤小,以及患者术后舒适度高、恢复快、住院时间缩短、住院费用降低的特点,符合ERAS理念。

Objective To investigate the application of non-intubated anesthesia(NIA)in endoscopic thoracic sympathectomy(ETS)for patients with primary hyperhidrosis(PH),and to promote the practice of enhanced recovery after surgery(ERAS)in ETS.Methods Methods 37 patients with PH undergone bilateral ETS were retrospectively analyzed.The patients were divided into NIA group(n=12)and intubated group(n=25);the right thoracic sympathetic nerve was cut off firstly at T3 level,and then the left thoracic sympathetic nerve at T4 level for all patients.Routine monitoring and palm temperature monitoring were arranged,and mean arterial pressure(MAP),heart rate(HR)and oxygen saturation(SpO_2)were recorded at four different time points as t_1(before anesthesia),t_2(when the right T3 was cut),t_3(when the left T4 was cut)and t_4(after surgery).Different indexes were compared between the two groups,such as anesthesia time,operation time,postoperative hospital stay,postoperative VAS,postoperative complications and the total cost of hospitalization.Results There was no significant difference in MAP,HR and SpO_2 between the two groups at the same time point(P>0.05).There was no significant difference in the operation time between the two groups(P> 0.05).The palm temperature gradually increased after ETS by(1.6-2.9)℃,an average of(2.2±0.6)℃.Patients in NIA group had a shorter anesthesia time,less postoperative hospital stay,less VAS score and postoperative complications(P<0.05).The cost of hospitalization was significantly lower in NIA group than those of intubated group(P <0.05).Conclusions The application of NIA in the bilateral ETS has the advantages of less injury,more comfortable postoperative experience,faster postoperative recovery,shorter hospitalization time and less hospitalization cost,in accordance with the concept of ERAS.