保留自主呼吸不插管与气管插管单肺通气在老年患者单孔胸腔镜手术的应用对比

Comparison of non-intubated spontaneous breathing and endotracheal intubation with one-lung ventilation in uniportal thoracoscopic surgery in elderly patients

目的探究保留自主呼吸不插管全身麻醉(全麻)在老年患者单孔胸腔镜手术的应用价值。方法回顾分析于2020年3月至2021年12月入住我院的86例单孔胸腔镜手术的老年患者的临床资料。根据麻醉插管方式不同分为保留自主呼吸不插管电视胸腔镜手术组(NI-VATS组)和气管插管单肺通气电视胸腔镜手术组(OLV-VATS组)。两组各43例,比较两组麻醉准备时间、麻醉清醒时间、术中肺萎陷评分、纵隔摆动评分及术后炎症指标、进食时间、消化道反应、咽痛、术后肺不张、住院时间等。结果NI-VATS组与OLV-VATS组比麻醉准备时间短[(19.8±2.6)min和(32.3±4.5)min,t=-15.77,P<0.001]、麻醉清醒时间短[(6.8±2.1)min和(11.9±2.9)min,t=-9.485,P<0.001],术中手术视野稍差,包括肺萎陷评分[(2.5±0.7)分和(1.8±0.7)分,t=4.704,P=<0.001]、纵隔摆动[(2.1±0.6)分和(1.3±0.5)分,t=6.514,P<0.001];包括术后当天白细胞计数(×10^(9)/L)[(12.07±1.28)和(12.60±1.56),t=-1.748,P=0.084]、C反应蛋白(CRP)[(27.62±14.66)mg/L和(29.08±12.01)mg/L,t=-0.506,P=0.614]、术后第1天白细胞计数(×10^(9)/L)[(10.62±1.30)和(11.12±1.56),t=-1.609,P=0.111]二组比较差异均无统计学意义;降钙素原(PCT)二组比较差异有统计学意义[(0.189±0.130)μg/L和(0.264±0.123)μg/L,t=-2.744,P=0.007];进食时间提早[(3.4±1.0)h和(5.5±1.0)h,t=-9.55,P<0.001]、消化道反应比例下降(4.7%和20.9%,χ^(2)=5.108,P=0.024)、咽痛发生率下降(4.7%和23.3%,χ^(2)=6.198,P=0.013)、住院时间缩短[(3.8±0.3)d和(4.9±0.8)d,t=-7.266,P<0.001]。结论对于行单孔胸腔镜手术的老年患者,保留自主呼吸不插管虽然对于手术视野有一定影响,但能缩短麻醉及清醒时间,不增加麻醉及手术并发症,利于患者术后的快速恢复,值得推广。

Objective To explore the practical value of general anesthesia with non-intubated spontaneous breathing in uniportal thoracoscopic surgery in elderly patients.MethodsClinical data of 86 elderly patients undergone uniportal thoracoscopy surgery during hospitalization at our hospital between March 2020 and December 2021 were retrospectively reviewed and analyzed.Based on the anesthesia intubation method,they were divided into a non-intubated spontaneous breathing video-assisted thoracic surgery group(NI-VATS group)and a one-lung ventilation video-assisted thoracic surgery group(OLV-VATS group),with 43 cases in each group.Data were compared on the inflammatory indexes,preparation time for anesthesia,time to awakening after anesthesia,intraoperative lung collapse score,mediastinal flutter score,time to postoperative feeding,digestive tract complications,sore throat,postoperative pulmonary atelectasis,and hospitalization time.ResultsCompared with the OLV-VATS group,the NI-VATS group had a shorter anesthesia preparation time[(19.8±2.6)min vs.(32.3±4.5)min,t=-15.77,P<0.001]and a shorter time to awakening[(6.8±2.1)min vs.(11.9±2.9)min,t=-9.485,P<0.001],slightly poorer operating field during surgery,an unfavorable lung collapse score[(2.5±0.7)vs.(1.8±0.7)t=4.704,P<0.001],worse mediastinal flutter[(2.1±0.6)vs.(1.3±0.5),t=6.514,P<0.001].Lower procalcitonin(PCT)[(0.189±0.130)μg/L vs.(0.264±0.123)μg/L,t=-2.744,P=0.007),a shorter time to postoperative feeding[(3.4±1.0)h vs.(5.5±1.0)h,t=-9.55,P<0.001],and lower rates of digestive tract reactions(4.7%vs.20.9%,χ^(2)=5.108,P=0.024)and throat pain(4.7%vs.23.3%,χ^(2)=6.198,P=0.013),and a shorter length of hospital stay[(3.8±0.3)d vs.(4.9±0.8)d,t=-7.266,P<0.001].ConclusionsFor the elderly patients undergoing uniportal thoracoscopic surgery,non-intubated spontaneous breathing may somewhat obstruct the operating field,but it can shorten the time of anesthesia and the time to awakening,does not increase complications from anesthesia and surgery,favors rapid postoperative recovery for patients and therefore should be promoted.