基于保留自主呼吸下LMA-Fastrach喉罩联合椎旁神经、星状神经节阻滞在胸腔镜手术中的应用

The application of LMA-astrach laryngeal mask combined with paravertebral nerve and stellate ganglion block in thoracoscopic surgery with reserved spontaneous breathing

目的:评估LMA-Fastrach喉罩联合椎旁神经、星状神经节阻滞在胸腔镜手术中应用的安全性和有效性。方法:选择全麻下胸腔镜手术治疗病人80例,按照随机数字表法分为2组,分别采用传统的双腔管支气管麻醉组(T组)和LMA-Fastrach喉罩联合椎旁神经、星状神经节阻滞麻醉组(M组)。观察记录2组病人术后咽痛、声嘶、肺不张发生率;2组病人插管后(T0)、手术开始后10 min(T1)、手术开始后30 min(T2)、手术结束前10 min(T3)动脉血气分析结果及气道压;记录2组病人术中麻醉药使用总剂量、拔管时间、恢复室停留时间;术后2 h(T4)、24 h(T5)、48 h(T6)VAS评分、睡眠质量、炎症因子含量。结果:2组病人咽痛、声音嘶哑、肺不张发生率比较差异均无统计学意义(P>0.05)。T组围手术期瑞芬太尼、舒芬太尼使用量、气管拔管时间、恢复室停留时间均高于M组(P<0.01)。T4时间点T组镇痛评分及各炎症因子均高于M组(P<0.01);T5时间点T组镇痛评分、睡眠质量评分及各炎症因子均高于M组(P<0.01);T6时间点T组镇痛评分和睡眠质量评分高于M组(P<0.01和P<0.05)。T1时间点T组气道压显著高于M组(P<0.01);T2时间点T组PaO2和气道压高于M组(P<0.05和P<0.01);T3时间点PaO2显著高于M组(P<0.01)。结论:LMA-Fastrach喉罩联合椎旁神经、星状神经节阻滞在胸腔镜手术中应用安全有效。

Objective:To evaluate the safety and efficacy of LMA-Fastrach laryngeal mask combined with paravertebral nerve and stellate ganglion block in thoracoscopic surgery.Methods:Eighty patients treated with thoracoscopic surgery under general anesthesia were randomly divided into the group T and group M.The group T were treated with conventional double lumen bronchial anesthesia,and the group M were treated with LMA-Fastrach laryngeal mask combined with paravertebral nerve and stellate ganglion block anesthesia.The incidence rates of postoperative pharynx pain,hoarseness and atelectasis in two groups were observed and recorded.The results of arterial blood gas analysis and airway pressure in two groups after intubation(T0),after 10 min of operation(T1),after 30 min of operation(T2)and before 10 min of the end of operation(T3)were analyzed.The total intraoperative anesthetic dose,extubation time and recovery room residence time were recorded in two groups.The VAS score,sleep quality and inflammatory cytokines content after 2 h(T4),24 h(T5)and 48 h(T6)of surgery were recorded.Results:There was no statistical significance in the incidence rates of pharynx pain,hoarseness and atelectasis between two groups(P>0.05).The perioperative usage of remifentanil and sufentanil,endotracheal extubation time and recovery room residence time in group T were higher than those in group M(P<0.01).The analgesia score and inflammatory factors in group T were higher than those in group M at T4 time point(P<0.01).The analgesia score,sleep quality score and inflammatory factors in group T were higher than those in group M at T5 time point(P<0.01).The analgesia score and sleep quality score in group T were higher than those in group M at T6 time point(P<0.01 and P<0.05).The airway pressure in group T was significantly higher than that in group M at T1(P<0.01).The PaO2 and airway pressure in group T were higher than those in group M at T2(P<0.05 and P<0.01).The PaO2 in group T at T3 was significantly higher than that in group M(P<0.01).Conclusions:The LMA-Fastrach laryngeal mask combined with paravertebral nerve and stellate ganglion block is safe and effective in thoracoscopic surgery.