免气管插管麻醉技术在肺磨玻璃结节楔形切除术中的应用效果研究

Effects of non⁃intubated anesthesia on clinical outcomes and subtypes of white blood cells in the patients undergoing thoracic surgery

目的探讨免气管插管麻醉技术对肺磨玻璃结节患者肺叶楔形切除术临床安全性、术后康复和白细胞分群的影响。方法采用前瞻性配对队列研究纳入2018年1月至2019年12月在上海市长海医院接受电视胸腔镜下肺叶楔形切除术患者,其中自愿接受免气管插管的椎旁阻滞复合中深度镇静麻醉方式的22例患者为试验组,采取传统双腔气管插管全身麻醉的方式实施麻醉的22例患者为对照组。比较2组患者术后血常规中白细胞分群的变化、术中血流动力学变化、麻醉和手术时间、引流管留置时间和住院时间等指标。结果试验组患者术后引流管留置时间显著短于对照组(P<0.05),术中最高与最低收缩压和舒张压均高于对照组(P<0.05),术中最低血氧饱和度显著低于对照组(P<0.05)。术后血常规显示,试验组患者术后2 h中性粒细胞/淋巴细胞比值、术后第2天白细胞计数、中性粒细胞计数、单核细胞/淋巴细胞比值、中性粒细胞/淋巴细胞比值均显著低于对照组(P<0.05),但是淋巴细胞计数显著高于对照组(P<0.05)。结论与传统全身麻醉技术相比,免气管插管麻醉技术安全有效,可预防肺磨玻璃结节手术患者术后淋巴细胞降低以及中性粒细胞/淋巴细胞和单核细胞/淋巴细胞比值上升。

Objective To investigate the effects of the non-intubated anesthesia on the clinical safety, postoperative recovery and changes in the subtypes of white blood cells in the patients with pulmonary ground-glass opacity undergoing pulmonary wedge resection.Methods 44 patients who underwent pulmonary wedge resection under non-intubated anesthesia from January 2018 to December 2019 were recruited for the prospective paired cohort study, and 22 patients who voluntarily received pulmonary wedge resection under non-intubated anesthesia were designated as the treatment group, while another 22 patients who experienced the same surgery under conventional general anesthesia were designated as the control group. Changes in the subtypes of white blood cells after surgery were compared between the patients of the 2 groups. Comparisons were also made in the changes of hemodynamics during surgery, anesthesia and surgery duration, drainage and hospitalization time between the patients of the two groups.Results The drainage retention duration after surgery for the treatment group was significantly shorter than that for the control group, and the maximal and minimal systolic and diastolic pressures of the former were all higher than those of the latter. However, minimal oxygen saturation in the blood stream(SpO;) during surgery was significantly lower for the treatment group than that for the control group.Postoperative blood routine tests showed that the neutrophil-to-lymphocyte ratio at hour 2 after surgery, white blood cell counts, neutrophil counts, neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio at day 2 after surgery were all significantly lower than those of the control group. However, the lymphocyte counts was significantly higher than those of the control group.Conclusion Compared with conventional general anesthesia, non-intubated anesthesia is safer and more effective. It could prevent reduction of lymphocyte counts and elevation of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in the patients with pulmonary ground-glass opacity undergoing surgery.