胸椎旁置管阻滞复合保留自主呼吸的非气管插管麻醉在胸腔镜手术中的应用

Application of Thoracic Paravertebral Block Combined with Non-Tracheal Intubation Anesthesia with Spontaneous Breathing in Thoracoscopic Surgery

目的探讨胸椎旁置管阻滞复合保留自主呼吸的非气管插管麻醉在胸腔镜手术中的应用效果。方法将56例行胸腔镜手术患者按随机数字表法分为对照组和研究组,每组28例。对照组采取气管插管麻醉,研究组采取胸椎旁置管阻滞复合保留自主呼吸的非气管插管麻醉。观察2组麻醉前(T0),开胸后15 min(T1)、开胸后30 min(T2)和关胸后15 min(T3)、关胸后30 min(T4)的心率(HR)、平均动脉压(MAP)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、脉搏血氧饱和度(SpO2)及手术相关指标(包括术前麻醉时间、手术时间、术后进食时间、术后下地活动时间、住院时间等)、不良反应(包括咽喉不适感、恶心呕吐、肺部感染等)发生率。结果与T0比较,研究组T1、T2时HR水平均明显升高,PaCO2、MAP、PaO2、SpO2水平均明显下降,而对照组T1、T2时HR、MAP、PaO2水平均明显升高(均P<0.05)。2组T3时HR、MAP、PaO2、PaCO2、SpO2水平与T4比较差异无统计学意义(P>0.05);研究组T1、T2时HR、MAP、PaO2、SpO2水平均明显低于对照组,PaCO2水平明显高于对照组(P<0.05)。研究组不良反应发生率低于对照组(0.0%比21.43%,P<0.05)。结论胸椎旁置管阻滞复合保留自主呼吸的非气管插管麻醉用于胸腔镜手术具有较好的麻醉效果,且安全性较高。

Objective To explore the efficacy of thoracic paravertebral block combined with non-tracheal intubation anesthesia with spontaneous breathing in thoracoscopic surgery.Methods Fifty-six patients undergoing thoracoscopic surgery were randomly divided into two groups,with 28 cases in each group.The control group received tracheal intubation anesthesia.The study group received thoracic paravertebral block and non-tracheal intubation anesthesia with spontaneous breathing.Heart rate(HR),mean arterial pressure(MAP),arterial blood oxygen partial pressure(PaO2),arterial blood carbon dioxide partial pressure(PaCO2)and pulse blood oxygen saturation(SpO2)were observed before anesthesia(T0),15 minutes after thoracotomy(T1),30 minutes after thoracotomy(T2),15 minutes after thoracotomy closure(T3)and 30 minutes after thoracotomy closure(T4).In addition,surgical indicators(preoperative anesthesia time,operation time,time to postoperative feeding,time to out-of-bed activities,length of hospital stay,etc.)and incidence of adverse reactions(throat discomfort,nausea and vomiting,pulmonary infection,etc.)were measured in both groups.Results Compared with T0,HR increased and PaCO2,MAP,PaO2 and SpO2 decreased in study group,but HR,MAP and PaO2 increased in control group at T1 and T2(P<0.05).There were no significant differences in HR,MAP,PaO2,PaCO2 and SpO2 between T3 and T4 in both groups(P>0.05).Compared with control group,HR,MAP,PaO2 and SpO2 decreased and PaCO2 increased in study group at T1 and T2(P<0.05).Moreover,the incidence of adverse reactions in study group was lower than that in control group(0.0% vs 21.43%,P<0.05).Conclusion Thoracic paravertebral block combined with non-tracheal intubation anesthesia with spontaneous breathing preservation is effective and safe for thoracoscopic surgery.