不插管保留自主呼吸麻醉在胸腔镜手术治疗手汗症的应用研究

Study on the application of anesthesia keeping spontaneous breathing without intubation in the treatment of palmar hyperhidrosis during thoracoscopic surgery

目的探讨不插管保留自主呼吸麻醉胸腔镜手术治疗手汗症患者的临床价值。方法选择2020年12月至2022年11月钦州市第一人民医院40例行胸腔镜下胸交感神经链切断术的手汗症患者为研究对象,随机分为对照组(气管插管全身麻醉手术)与观察组(不插管保留自主呼吸麻醉手术),每组各20例。观察比较围手术期相关指标,比较术后咽痛发生率、咳嗽评分及术后并发症发生情况,检测炎症因子水平并比较患者住院时间及住院费用。结果观察组术前麻醉诱导时间、术后苏醒时间短于对照组,差异有统计学意义(P<0.05),两组手术时间、术中出血量、手掌温度升高程度、术中最低血氧饱和度(SpO2)水平比较,差异无统计学意义(P>0.05);观察组咽痛发生率、咳嗽评分低于对照组,咳嗽持续时间短于对照组,差异有统计学意义(P<0.05),观察组气胸、肺炎发生率相对低,但差异无统计学意义(P>0.05);术后1 d两组患者白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均高于同组术前,差异有统计学意义(P<0.05),观察组术后1 d的IL-6、TNF-α、CRP水平低于对照组,差异有统计学意义(P<0.05);观察组术后白细胞计数水平、住院费用低于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。结论在手汗症患者胸腔镜手术治疗中实施不插管保留自主呼吸麻醉可行性较高,有利于降低术后气道损伤及肺部感染等相关并发症的发生风险,以加快患者术后恢复,缩短住院时间,取得更为良好的预后结果,值得借鉴及推广。

Objective To explore the clinical value of anesthesia keeping spontaneous breathing without intubation in thoracoscopic surgery for the treatment of patients with palmar hyperhidrosis.Methods A study was conducted from December 2020 to November 2022 at the First People’s Hospital of Qinzhou.40 patients with palmar hyperhidrosis who underwent thoracoscopic sympathectomy were randomly divided into two groups,the control group(general anesthesia surgery with tracheal intubation)and the observation group(surgery with anesthesia keeping spontaneous breathing without intubation),with 20 patients included in each group;perioperative related indicators were observed and compared,postoperative pharyngeal pain incidence,cough score,and postoperative complication rate were compared,levels of inflammatory factors were detected,and patient hospitalization time and expenses were compared.Results The preoperative anesthesia induction time and postoperative recovery time in the observation group were shorter than those in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the operation time,intraoperative blood loss,the degree of palm temperature rise,and the level of the lowest saturation of pulse oxygen(SpO2)in the two groups were compared(P>0.05);The incidence of pharyngeal pain and cough score in the observation group were lower than those in the control group,and the duration of cough was shorter than that in the control group,with s tatistically significant differences(P<0.05).The incidence of pneumothorax and pneumonia in the observation group was relatively low,but there was no statistically significant difference between the groups(P>0.05).On the first day after surgery,the levels of interleukin-6(IL-6),tumor necrosis factor(TNF),and C-reactive protein(CRP)in both groups of patients were higher than those in the same group before surgery,with statistically significant differences(P<0.05).The levels of IL-6,TNF-α,and CRP in the observation group were lower than those in the control group on the first day after surgery,with statistically significant differences(P<0.05);The observation group had lower postoperative white blood cell count levels,lower hospitalization expenses,and shorter hospitalization time compared to the control group,with statistically significant differences(P<0.05).Conclusion The feasibility of implementing anesthesia keeping spontaneous breathing without intubation in thoracoscopic surgery for patients with palmar hyperhidrosis is relatively high,which is beneficial for reducing the risk of postoperative complications such as airway injury and lung infection,accelerating postoperative recovery,shortening hospitalization time,and achieving better prognosis.It is worth learning from and promoting.