超声引导胸椎旁神经阻滞联合喉罩全身麻醉在胸腔镜肺叶切除手术中的应用

Application of Ultrasound-guided Thoracic Paravertebral Nerve Block Combined with Laryngeal Mask General Anesthesia in Thoracoscopic Lobectomy

目的探讨超声引导下第4胸椎(T_(4))椎旁神经阻滞联合喉罩全身麻醉术中保留自主呼吸用于胸腔镜肺叶切除手术的安全性和可行性。方法选择2021年2—12月于本溪市中心医院行胸腔镜肺叶切除手术患者40例,随机分为喉罩组和双腔管组各20例。喉罩组采用超声引导T_(4)椎旁神经阻滞+喉罩全身麻醉方法;双腔管组采用插双腔气管导管全身麻醉方法。记录两组患者的一般情况;记录麻醉时间､手术时间､苏醒时间､术后住院时间及住院费用;记录两组患者插喉罩/管前后的平均动脉压差值及心率差值;记录术野暴露情况评分;记录术中呼末二氧化碳(P_(ET)CO_(2))最大值;统计术中出现低氧血症(SPO_(2)0.05)。两组都无低氧血症发生。喉罩组无咳嗽､喉罩移位及中转插管情况。喉罩组住院时间及住院费用均低于双腔管组,差异均有统计学意义(均P<0.05);插喉罩/管前后的平均动脉压差值及心率差值喉罩组均低于双腔管组,差异均有统计学意义(均P<0.05);喉罩组苏醒时间更短;术后恶心呕吐､咽喉不适､声音嘶哑等不良反应喉罩组均优于双腔管组,差异均有统计学意义(均P<0.05);术中P_(ET)CO_(2)最大值喉罩组高于双腔管组,差异有统计学意义(P<0.05)。结论超声引导下T_(4)椎旁神经阻滞联合喉罩全身麻醉保留自主呼吸的方法具有气道损伤轻､术后恢复快､花费少等优势,可安全用于胸腔镜肺叶切除手术。

Objective To investigate the safety and feasibility of ultrasound-guided T_(4)paravertebral nerve block combined with laryngeal mask general anaesthesia for thoracoscopic lobectomy with preservation of spontaneous breathing during surgery.Methods Forty patients underwent thoracoscopic lobectomy in Benxi Central Hospital from February 2021 to December 2021,and were randomly divided into throat mask group and double-lumen tube group(20 patients in each group).The throat mask group used ultrasound-guided T_(4)paravertebral nerve block+laryngeal mask general anaesthesia,and the double-lumen tube group used general anaesthesia with double-lumen endotracheal tube insertion.The general conditions of the patients in both groups were recorded,and the anaesthesia time,operation time,awakening time,postoperative hospitalization time and hospitalization cost were recorded.The difference in mean arterial pressure and heart rate before and after insertion of the laryngeal mask/tube was recorded.The scores of the exposure of the operation field were recorded.The maximum value of intraoperative end-expiratory carbon dioxide(P_(ET)CO_(2))was recorded,and the number of cases of intraoperative hypoxemia(SPO_(2)0.05).There was no occurrence of hypoxaemia in both groups.There was no coughing,laryngeal mask displacement and intermediate intubation in laryngeal mask group.The hospitalization time and hospitalization cost of laryngeal mask group were significantly lower than that of double-lumen tube group(all P>0.05).The difference in the mean arterial pressure and heart rate before and after insertion of the laryngeal mask/tube in laryngeal mask group were significantly lower than that of double-lumen tube group(all P<0.05).The awakening time of laryngeal mask group was shorter,and the adverse reactions such as nausea and vomiting,throat discomfort,voice hoarseness,and adverse reaction in laryngeal mask group were all superior to double-lumen tube group(all P<0.05).The intraoperative P_(ET)CO_(2)maxima in laryngeal mask group were significantly higher than p double-lumen tube group(P<0.05).Conclusion Ultrasound-guided T_(4)paravertebral nerve block combined with laryngeal mask general anaesthesia for preserving autonomous breathing has the advantages of light airway damage,fast postoperative recovery and less expense,and can be safely used in thoracoscopic lobectomy.