无管胸腔镜手术与传统胸腔镜手术的对比分析

The Comparative Analysis of Tubeless Thoracoscopic Surgery and Traditional Thoracoscopic Surgery

目的对比分析保留自主呼吸非插管全麻无管胸腔镜手术与传统插管全麻胸腔镜手术的疗效差异。方法收集2017年1月—2019年1月因肺大泡破裂导致气胸于本院住院治疗患者资料45例,分为治疗组20例和对照组25例,治疗组麻醉采用静脉全麻联合局麻,不留置尿管,术后不留置胸管;对照组麻醉采用传统双腔管插管全联合肋间神经阻滞,留置尿管,术后留置胸管引流。两组患者均行单孔胸腔镜肺大泡切除。对比分析两组患者麻醉复苏时间等麻醉指标,手术时间、术中出血量、术后疼痛评分等手术指标等。结果治疗组患者麻醉时间短于对照组,呛咳发生例数少于对照组,麻醉复苏时间短于对照组,咽部不适例数少于对照组,差异均有统计学意义(P<0.05)。两组患者肺萎陷程度、手术时间、术中出血量、肺复张程度差异无统计学意义(P>0.05)。治疗组患者术后引流量、拔管时间、尿道不适感,与对照组对比,差异具有统计学意义(P<0.05)。治疗组患者术后疼痛评分低于对照组,住院时间短于对照组,肺部感染例数低于对照组,差异具有统计学意义(P<0.05)。结论无管单孔胸腔镜手术在选择性患者中是安全和有效的方式,能够加速患者的康复,减少创伤。

Objective To compare and analyze the difference of curative effect between tubeless thoracoscopic surgery and traditional thoracoscopic surgery under non-intubated general anesthesia with autonomous breathing.Methods The data of 45 patients were collected from January 2017 to January 2019 for pneumothorax caused by bullae rupture in our hospital.They were divided into treatment group(20 cases)and control group(25 cases).The treatment group was received intravenous general anesthesia combined with local anesthesia without indwelling urinary catheter and thoracic catheter after operation.The control group was anesthetized with traditional double-lumen intubation combined with intercostal nerve block,indwelling urinary catheter and thoracic drainage after operation.Single-port thoracoscopic bullaectomy was performed in both groups.The anesthesia indexes such as anesthesia resuscitation time,operation index such as operation time,intraoperative bleeding volume and post-operative pain score were compared and analyzed between the two groups.Results The anesthesia time of the treatment group was shorter than that of the control group,the number of cough cases was less than that of the control group,the anesthesia resuscitation time was shorter than that of the control group,and the number of pharyngeal discomfort cases was less than that of the control group,the difference was statistically significant(P<0.05).There was no significant difference in the degree of lung collapse,operation time,intraoperative bleeding volume and lung recruitment between the two groups(P>0.05).There was no difference between postoperative drainage,extubation time and urethral discomfort in the treatment group,compared with the control group,the difference was statistically significant(P<0.05).The VAS score of patients in treatment group was lower than that of control group,hospitalization time was shorter than that of control group,and the number of cases of pulmonary infection was lower than that of control group.The difference was statistically significant(P<0.05).Conclusion Tubeless single-hole thoracoscopic surgery is a safe and effective method in selective patients,which can accelerate the recovery of patients and reduce trauma.