胸椎旁神经阻滞复合保留自主呼吸的非气管插管麻醉在胸腔镜手术中应用的临床分析

Clinical analysis of thoracoscopic surgery under parathoracic nerve block combined with non-tracheal intubation anesthesia preserving autonomous breathing

目的:探讨胸椎旁神经阻滞复合保留自主呼吸的非气管插管麻醉在胸腔镜手术中的应用效果。方法:选择外科行胸腔镜手术的患者60例,根据治疗方法分为2组,各30例,对照组实施气管插管全身麻醉,观察组实施胸椎旁神经阻滞复合保留自主呼吸的非气管插管麻醉,比较两组的麻醉效果、生命体征指标、动脉血氧指标、不良反应发生率、麻醉时间、手术时间、术后麻醉苏醒情况和认知功能评分。结果:麻醉优良率观察组略优于对照组(96.67%vs.93.30%,P>0.05)。两组的收缩压、舒张压、心率在麻醉前后相比均无明显变化(P>0.05)。两组的PaO_(2)、SpO_(2)、PaCO_(2)在围术期间相比无明显变化(P>0.05),两组手术后的PaO_(2)和SpO_(2)和PaCO_(2)比较均无差异(P>0.05)。不良反应发生率在观察组中为0,低于对照组13.33%(P<0.05)。观察组麻醉时间、手术时间术后自主呼吸恢复时间、呼之可睁眼时间、定向力恢复时间均短于对照组(P<0.05)。两组手术后48 h的MMSE、MoCA评分明显低于术前(P<0.05),且观察组中均高于对照组(P<0.05)。结论:胸椎旁神经阻滞复合保留自主呼吸的非气管插管麻醉用于胸腔镜手术中,可在保证麻醉效果、维持生命体征和动脉血氧状况稳定的前提下,减少不良反应,缩短手术时间,加快术后苏醒,减轻术后认知功能障碍。

Objective:To explore the application effect of thoracic paravertebral nerve block combined with non-tracheal intubation anesthesia preserving spontaneous respiration in thoracoscopic surgery.Methods:Sixty patients who underwent thoracoscopic surgery in thoracic surgery were divided into two groups,30 cases in each group.The control group received tracheal intubation general anesthesia,while the observation group received thoracic paravertebral nerve block combined with non-tracheal intubation anesthesia retaining spontaneous breathing.The anesthesia effect,vital signs index,arterial oxygen index,incidence rate of adverse reactions,anesthesia time,operation time,postoperative anesthesia recovery and cognitive function scores of the two groups were compared.Results:The excellent and good rate of anesthesia in the observation group was slightly better than that in the control group(96.67%vs.93.30%,P>0.05).The systolic blood pressure,diastolic blood pressure,and heart rate of the two groups had no significant changes before and after anesthesia(P>0.05).PaO_(2),SpO_(2)and PaCO_(2)of the two groups had no significant changes during the perioperative period(P>0.05),and there was no difference in PaO_(2),SpO_(2),PaCO_(2)between the two groups after surgery(P>0.05).The incidence of adverse reactions was 0%in the observation group,which was lower than 13.33% in the control group(P<0.05).The observation group’s anesthesia time,the postoperative spontaneous breathing recovery time,the time to open the eyes after the operation,and the orientation recovery time were shorter than those of the control group(P<0.05).The MMSE and MoCA scores of the two groups at 48 hours after surgery were significantly lower than those before surgery(P<0.05),and the scores of the observation group were higher than those of the control group(P<0.05).Conclusion:Thoracoscopic surgery with thoracic paravertebral nerve block combined with non-tracheal intubation anesthesia preserving spontaneous breathing can reduce adverse reactions,shorten operation time,accelerate postoperative recovery and reduce postoperative cognitive dysfunction on the premise of ensuring anesthesia effect,maintaining vital signs and stable arterial oxygen status.