保留自主呼吸麻醉对肺大疱切除术患者呼吸的病理生理影响

Pathophysiological effect of autonomic respiratory anesthesia on pulmonary bullectomy patients

目的评估自主呼吸麻醉与双腔气管插管全身麻醉对肺大疱切除术(VATS)患者呼吸生理和气道炎症影响的研究。方法回顾性分析于2017年9月~2019年5月我院胸心外科行VATS手术的95例局限性肺大疱伴/不伴自发性气胸患者临床资料,根据麻醉方式分为对照组(双腔气管插管全身麻醉下行VATS肺大疱切除术,52例)和观察组(自主呼吸静脉麻醉下行VATS肺大疱切除术,43例),比较两组术中、术后血气指标、炎症反应指标及术后恢复情况。结果两组患者术中及术后1h PaO 2、PaCO 2、血乳酸水平差异无统计学意义(P>0.05);术后12h及术后48h,观察组患者外周血白细胞数、中性粒细胞数、PCT水平均显著低于对照组,差异有统计学意义(P<0.05);观察组及对照组手术总时间[(65.6±15.7)min,(114.3±26.6)min,P<0.05],疼痛VAS评分[(2.5±0.8),(5.3±1.0),P<0.05];观察组术后进食早,抗生素使用时间及住院时间短,手术费用低,拔管时间差异均有统计学意义(P<0.05)。结论自主呼吸麻醉下VATS肺大疱切除术治疗肺大疱伴/不伴自发性气胸安全有效,与传统手术相比具有降低炎症反应、促进术后康复等优势,值得推广。

Objective To evaluate the effect of spontaneous respiratory anesthesia and tracheal intubation under general anesthesia on respiratory physiology and airway inflammation for VATS bullous resection.Methods The clinical data of 95 patients with localized bullae of the lung with or without spontaneous pneumothorax who underwent VATS from September 2017 to May 2019 were retrospectively analyzed.According to the anesthesia method,the patients were divided into the control group(52 cases of VATS bullaectomy under general anesthesia with double-lumen endotracheal intubation)and the observation group(43 cases of VATS bullaectomy under autonomous respiratory intravenous anesthesia).The intraoperative and postoperative blood gas indexes,inflammatory reaction index and postoperative recovery were compared between the two groups.Results There was no significant difference in PaO 2,PaCO 2 and blood lactate levels between the two groups(P>0.05).The number of peripheral blood leukocytes and neutrophils were observed in the observation group 12h and 48h after operation.The PCT level was significantly lower in the observation group than in the control group(P<0.05).The total operation time of the observation group and the control group was(65.6±15.7)min and(114.3±26.6)min,and pain VAS scores were(2.5±0.8)and(5.3±1.0),respectively(P<0.05).The observation group had earlier eating,shorter antibiotic use time and hospital stay,lower operation cost was low,and shorter extubation time(P<0.05).Conclusion VATS bullous resection under spontaneous anesthesia is safe and effective in treatment of pulmonary bullous with or without spontaneous pneumothorax.Compared with traditional surgery,it has the advantages of reducing inflammation and promoting postoperative recovery,which is worthy of wide promotion.