基于ERAS理念的非气管插管麻醉管理策略对胸腔镜手术患者应激反应的影响及安全性评价

Effects of non-tracheal intubation anesthesia management strategies on stress response in thoracoscopic surgery and its safety evaluation based on ERAS

目的探讨以促进术后康复为目标导向的麻醉管理策略在非气管插管保留自主呼吸胸腔镜手术中应用的安全性与可行性。方法选择行胸腔镜手术患者60例,分为ERAS+非气管插管保留自主呼吸组(E组)与常规管理+双腔支气管插管单肺通气组(C组),每组30例。E组采用非气管插管、保留自主呼吸、胸段硬膜外阻滞+静脉镇痛镇静+术中迷走神经阻滞、ERAS理念优化患者术前、术中、术后管理,C组采用双腔支气管插管、静脉复合全身麻醉、常规进行患者术前、术中、术后管理。分别于麻醉诱导前(T0)、手术开始30 min(T1),术毕即刻(T2)、术后24 h(T3)抽取动脉血检测SaO_2、PaCO_2,抽取外周静脉血采用放射免疫法检测血浆中皮质醇(Cor)浓度,采用酶联免疫分析法检测血清去甲肾上腺素(NE)、肾上腺素(E)含量,同时比较两组患者手术时间、麻醉苏醒时间、住院时间、麻醉费用、术后VAS疼痛评分及并发症发生情况。结果与T0时比较,T1~T2时两组SaO_2下降,Pa CO2升高,E组T1~T2时PaCO_2高于C组,SaO_2低于C组(P<0.05);与T0时比较,T1~T3时两组Cor、E和NE浓度均升高(P<0.05);T1~T3时E组的Cor、E和NE均明显低于C组(P<0.05)。与C组比较,E组的麻醉苏醒时间、住院时间明显缩短,麻醉费用更低,术后VAS疼痛评分及术后并发症的发生率均明显降低。结论基于ERAS理念的非气管插管麻醉管理策略应用于保留自主呼吸胸腔镜手术中,通过优化术前、术中、术后患者管理,可以降低手术创伤应激反应,最小化不良反应,减少术后并发症,促进患者术后康复。

Objective To explore the safety and feasibility of anesthesia management strategy aiming at promoting postoperative rehabilitationin non-tracheal intubation.Methods Sixty patients with thoracoscopic surgery were divided into two groups:ERAS+non-endotracheal intubationgroup(group E)and conventional management group(30cases).E group with non-tracheal intubation,to retain spontaneous breathing,thoracic epiduralblock+intravenous analgesic sedation+intraoperative vagal block,ERAS concept to optimize the patients before surgery,intraoperative andpostoperative management,C group using double Bronchial intubation,intravenous compound general anesthesia,routine preoperative,intraoperative,postoperative management.The rats were sacrificed by radioimmunoassay(ROS).The levels of cortisol and plasma in the plasma were measuredby radioimmunoassay(T0),30min(T1),End time(T2),24h after surgery(T3)extraction SaO2,PaCO2arterial blood detection,extraction of peripheralvenous blood radioimmunity method is used to detect the plasma concentration of cortisol(Cor),using enzyme-linked immunoassay detectionserum norepinephrine(NE),and adrenaline(E)were measured by enzyme-linked immunosorbent assay(ELISA).The time of operation,anesthesiarecovery time,hospitalization time,anesthesia cost and postoperative VAS pain were compared between the two groups Score and complication.Results Compared with T0,PaCO2was higher than that in group C(P<0.05).The levels of Cor,E and NE in group E were significantly lower thanthose in group C(P<0.05).Compared with group C,the anesthesia awakening time,hospitalization time was shorter,the cost of anesthesia was lower,the postoperative VAS pain score and the incidence of postoperative complications were significantly reduced.Conclusion The strategy of nontrachealintubation anesthesia based on ERAS is applied to the maintenance of spontaneous breathing thoracoscopic surgery.By optimizing the preoperative,intraoperative and postoperative management,it can reduce the traumatic stress response,minimize the adverse reaction,Postoperative complications,to promote patients with postoperative rehabilitation.