免插管自主呼吸麻醉技术在胸腔镜手术中的应用效果分析

Effect analysis of non-intubated spontaneous breathing anesthesia in thoracoscopic surgery

目的研究免插管自主呼吸麻醉技术在胸腔镜手术中的应用效果,以期为患者快速康复提供新思路、新策略。方法40例择期行肺大疱、肺活检和手汗症等胸腔镜短小手术治疗的患者,按随机原则分成实验组和对照组,各20例。实验组在保留自主呼吸喉罩静脉麻醉+完善的区域阻滞下接受胸腔镜手术治疗,对照组于双腔气管插管全身麻醉单肺通气条件下接受胸腔镜手术。观察对比两组术中手术视野暴露满意情况、麻醉效果、手术时间、麻醉时间、术后恢复时间及手术前后白细胞计数(WBC)、中性粒细胞百分比(NEUT%)和术后并发症发生率。结果两组术中手术视野暴露满意情况对比差异无统计学意义(P>0.05)。两组麻醉效果对比差异无统计学意义(P>0.05)。两组手术时间、麻醉时间对比,差异无统计学意义(P>0.05);实验组术后进食时间(0.34±0.16)d、下地活动时间(0.69±0.22)d、住院时间(2.17±1.54)d均短于对照组的(0.62±0.37)、(1.18±0.65)、(5.85±2.30)d,差异有统计学意义(P<0.05)。相较于术前,两组术后24 h的WBC、NEUT%均降低,差异有统计学意义(P<0.05);术后24 h,实验组WBC(5.17±2.25)×10^(9)/L、NEUT%(60.31±7.20)%均低于对照组的(7.24±3.16)×10^(9)/L、(67.42±4.03)%,差异有统计学意义(P<0.05)。实验组患者术后胃肠道症状、声嘶、咽痛发生率分别为10.00%、5.00%、5.00%,均低于对照组的40.00%、50.00%、35.00%,差异有统计学意义(P<0.05)。结论免插管自主呼吸麻醉技术在胸腔镜手术中的应用效果确切,能获取满意的手术视野暴露和麻醉效果,缩短手术和麻醉时间,促进患者术后恢复,使患者尽早进食和下地活动,减少并发症发生,安全性高,值得推广。

Objective To study the application effect of non-intubated spontaneous breathing anesthesia in thoracoscopic surgery,so as to provide new ideas and strategies for rapid recovery of patients.Methods 40 patients who underwent elective thoracoscopic surgery for pulmonary bulla,lung biopsy and hyperhidrosis were randomly divided into an experimental group and a control group,each with 20 cases.The experimental group received thoracoscopic surgical treatment under laryngeal mask intravenous anesthesia with preserved spontaneous breathing+perfect regional block,and the control group received thoracoscopic surgery under general anesthesia with double-lumen tracheal intubation and single-lung ventilation.Observation and comparison were made on satisfactory exposure of the surgical field,anesthetic effect,operation time,anesthesia time,postoperative recovery time,and white blood cell counts(WBC)and neutrophil percentage(NEUT%)before and after surgery,and postoperative complications between the two groups.Results There was no significant difference in satisfactory exposure of the surgical field between the two groups(P>0.05).There was no significant difference in anesthesia effect between the two groups(P>0.05).There was no significant difference in operation time and anesthesia time between the two groups(P>0.05).The experimental group had eating time of(0.34±0.16)d,ambulation time of(0.69±0.22)d and hospitalization time of(2.17±1.54)d,which were all shorter than(0.62±0.37),(1.18±0.65)and(5.85±2.30)d in the control group.The difference was statistically significant(P<0.05).Compared with before surgery,WBC and NEUT%of both groups were decreased 24 h after surgery,and the difference was statistically significant(P<0.05).24 h after surgery,the experimental group had WBC of(5.17±2.25)×10^(9)/L and NEUT%of(60.31±7.20)%,which were lower than(7.24±3.16)×10^(9)/L and(67.42±4.03)%in the control group,and the difference was statistically significant(P<0.05).The incidence of postoperative gastrointestinal symptoms,hoarseness and pharyngeal pain in the experimental group were 10.00%,5.00%and 5.00%,which were lower than 40.00%,50.00%and 35.00%in the control group,and the difference was statistically significant(P<0.05).Conclusion The application effect of non-intubated spontaneous breathing anesthesia in thoracoscopic surgery is definite,which can obtain satisfactory exposure of surgical field and anesthesia effect,shorten the operation and anesthesia time,promote postoperative recovery of patients,enable patients to eat and go to the ground as soon as possible,reduce the occurrence of complications.It is safe and worthy of promotion.