不插管麻醉在剑突下单孔胸腔镜手术中的临床实践

Clinical analysis of nonintubated anesthesia in subxiphoid uniportal video-assisted thoracic surgery

目的探讨不插管麻醉在剑突下单孔胸腔镜手术中的可行性和安全性。方法收集同济大学附属上海市肺科医院2019年4月至2020年4月完成的60例不插管麻醉在经剑突下单孔胸腔镜手术中的病例资料。对围手术期并发症及处理措施、术后恢复和住院时间等情况进行分析总结,对不插管麻醉在剑突下单孔胸腔镜手术中的安全性和可行性进行评估。结果60例患者均在不插管麻醉下行剑突下单孔胸腔镜手术,包括肺叶切除术21例、肺段切除术7例、肺楔形切除术24例、胸腺切除术8例;肺叶切除术、肺段切除术、肺楔形切除术、胸腺切除术的手术时间分别为(71.8±25.7)min、(68.9±27.3)min、(41.5±11.1)min、(103.9±22.3)min,术中出血量分别为(47.6±18.4)ml、(45.6±16.8)ml、(26.5±13.3)ml、(65.8±24.5)ml;其中29例(48.3%)术中需要放置口咽通气道、17例(28.3%)出现术中低血压、9例(15.0%)发生心律失常,无术中知晓事件发生,4例(6.7%)发生术后并发症,无严重不良事件发生;平均住院时间(7±4.0)d。结论不插管麻醉在经剑突下入路单孔胸腔镜手术中具有可行性和一定优势,更多支持证据尚需大规模临床对照研究。

Objective To investigate the feasibility and security of nonintubated anesthesia(NA)in subxiphoid uniportal video-assisted thoracic surgery(SVATS).Methods A total of 60 consecutive cases underwent non-intubated SVATS between Apr.2019 to Apr.2020 in our hospital were performed.The perioperative complications and treatment measures,postoperative recovery and length of stay were summarized and analyzed.The safety and feasibility of NA in SVATS were evaluated.Results All the 60 patients successfully underwent SVATS with NA,including lobectomy in 21 cases,segmental resection in 7 cases,wedge resection in 24 cases,and thymotomy in 8 cases.The operation time was(71.8±25.7)min,(68.9±27.3)min,(41.5±11.1)min and(103.9±22.3)min respectively.The blood loss was(47.6±18.4)ml,(45.6±16.8)ml,(26.5±13.3)ml and(65.8±24.5)ml respectively.Among them,29(48.3%)cases needed to insert oropharyngeal airway;17(28.3%)cases had intraoperative hypotension;9(15.0%)cases had arrhythmia;4(6.7%)cases had postoperative complications;There was no serious adverse events of these patients.The average length of stay was(7±4.0)days.Conclusions NA is feasibility and has certain advantages in SVATS,large-scale clinical controlled studies are needed to provide more convincing evidence.