无气管内插管麻醉电视胸腔镜辅助肺切除术后患者快速康复的临床疗效观察

doi:10.3760/cma.j.cn101202-20210107-00009

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摘要目的评价无气管内插管麻醉电视胸腔镜手术(VATS)肺切除术后患者快速康复的临床疗效。方法回顾性队列研究。纳入2018年9月—2020年12月云南省第一人民医院胸外科行肺切除术患者228例,其中男118例、女110例,年龄30~76岁。根据麻醉方式不同分为无插管组(119例)和插管组(109例)。对比观察两组患者的基线资料、手术时间、术中出血量和手术相关并发症情况,以及术后快速康复相关指标,包括术后恢复经口饮食时间、通气时间、下床活动和住院时间、术后胸腔引流量及术后24 h疼痛视觉模拟评分法(VAS)评分等。结果两组患者年龄、性别、体质量指数(BMI)、病变类型和基础病史等基线资料比较,差异均无统计学意义(P值均＞0.05)。无插管组患者手术时间[120.0(60.0, 150.0)min]、术中出血量[40.0(20.0, 50.0)mL]、术后VAS评分[3.0(3.0, 4.0)分]、术后胸腔引流量[300.0(150.0, 545.0)mL]均低于插管组[130.0(90.0, 175.0)min、50.0(20.0, 100.0)mL、4.0(4.0, 4.0)分、510.0(90.0, 777.5)mL],术后恢复经口进食时间[1.5(1.0, 2.0)h]、下床活动时间[2.0(2, 2.5)h]和通气时间[1.0(1.0, 1.0)d]早于插管组[4.5(4.0, 5.0)h、12.0(10.0, 12.0)h和1.0(1.0, 1.0)d],差异均有统计学意义(Z=-2.229、-3.278、-8.000、-4.019、-13.310、-13.076和-3.297, P值均＜0.05)。两组患者住院时间、术后住院期间及出院后30 d内并发症发生率比较,差异无统计学意义(Z=-0.178, χ²=2.127、3.648, P值均＞0.05)。结论与插管麻醉相比,无气管内插管麻醉VATS肺切除术后患者早期快速康复的临床效果更好,值得临床外科推广。

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	蔡林生
	余扬
	宁显谷
	徐嘉阳
	叶佳
	刘荣胜
	戴俊
	徐珍珍
	陈新隆
	彭俊

关键词 ：麻醉,全身, 无气管内插管麻醉, 电视胸腔镜辅助肺切除, 加速康复外科

Abstract：Objective To analyze the clinical outcomes and reliability of rapid rehabilitation in patients who underwent pulmonary resection in video-assisted without endotracheal intubation.Methods The clinical data of 228 patients (118 males and 110 females) aged 30-76 years and who underwent pneumonectomy in the Department of Thoracic Surgery of the First People's Hospital of Yunnan Province from September 2018 to December 2020 were collected in this retrospective cohort study. The patients were divided into the non-intubated (119 cases) and intubated (109 cases) groups in accordance with the different anesthesia methods. The two groups of patients were compared in terms of baseline data, operation time, intraoperative blood loss, complications related to the operation situation, and rapid postoperative recovery related indicators, including recovery of the intake diet, exhaustion, off-bed activity and length of hospital stay, postoperative chest drainage, and pain visual analogue scale (VAS) score.Results No statistically significant difference occurred between the two groups as regards baseline data, such as age, body mass index, gender, lesion types, and background disease (all P values＞0.05). The operative time[120.0(60.0, 150.0)min], intraoperative blood loss[40.0(20.0, 50.0)mL], postoperative VAS score [3.0(3.0, 4.0)scores], and postoperative thoracic drainage flow[300.0(150.0, 545.0)mL] of patients in the non-intubation group were lower than those in the intubation group[130.0(90.0, 175.0)min, 50.0(20.0, 100.0)mL, 4.0(4.0, 4.0)scores, and 510.0(90.0, 777.5)mL], and postoperative oral recovery[1.5(1.0, 2.0)h], ambulation time[2.0(2, 2.5)h], and ventilation time[1.0(1.0, 1.0)d] of the without intubation group were significantly faster than the intubation group[4.5(4.0, 5.0)h、12.0(10.0, 12.0)h and 1.0(1.0, 1.0)d], the differences were statistically significant(Z=-2.229, -3.278, -8.000, -4.019, -13.310, -13.076, and -3.297,all P values＜0.05). No significant difference occurred between the two groups as regards length of hospital stay, and incidence of postoperative complications (all P values＞0.05).Conclusions Compared with intubation anesthesia, video-assisted thoracic surgery pneumonectomy without endotracheal intubation has better clinical effect on the early and rapid recovery of postoperative patients, an outcome which is worthy of clinical surgery promotion.

Key words： Anesthesia, general Non-intubation anesthesia Video-assisted thoracoscopic pneumonectomy Enhanced recovery after surgery

收稿日期: 2021-01-07

通讯作者: 彭俊, Email: 389647518@qq.com

引用本文:

蔡林生, 余扬, 宁显谷, 徐嘉阳, 叶佳, 刘荣胜, 戴俊, 徐珍珍, 陈新隆, 彭俊. 无气管内插管麻醉电视胸腔镜辅助肺切除术后患者快速康复的临床疗效观察[J]. 中华解剖与临床杂志, 2021, 26(6): 648-652.
Cai Linsheng, Yu Yang, Ning Xiangu, Xu Jiayang, Ye Jia, Liu Rongsheng, Dai Jun, Xu Zhenzhen, Cheng Xinlong, Peng Jun. Clinical effect of the rapid rehabilitation of patients following video-assisted thoracoscopic pneumonectomy without endotracheal intubation anesthesia. Chinese Journal of Anatomy and Clinics, 2021, 26(6): 648-652.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20210107-00009 或 http://www.cjac.com.cn/CN/Y2021/V26/I6/648

[1]	Mun M, Nakao M, Matsuura Y, et al. Video-assisted thoracoscopic surgery lobectomy for non-small cell lung cancer[J]. Gen Thorac Cardiovasc Surg, 2018, 66(11): 626-631. DOI:10.1007/s11748-018-0979-x.
[2]	Tikka T, Hilmi OJ. Upper airway tract complications of endotracheal intubation[J]. Br J Hosp Med (Lond), 2019, 80(8): 441-447. DOI:10.12968/hmed.2019.80.8.441.
[3]	Nezu K, Kushibe K, Tojo T, et al. Thoracoscopic wedge resection of blebs under local anesthesia with sedation for treatment of a spontaneous pneumothorax[J]. Chest, 1997, 111(1): 230-235. DOI:10.1378/chest.111.1.230.
[4]	Liu HY, Chiang XH, Hung MH, et al. Nonintubated uniportal thoracoscopic segmentectomy for lung cancer[J]. J Formos Med Assoc, 2020, 119(9): 1396-1404. DOI:10.1016/j.jfma.2020.03.021.
[5]	Gonzalez-Rivas D, Yang Y, Guido W, et al. Non-intubated (tubeless) uniportal video-assisted thoracoscopic lobectomy[J]. Ann Cardiothorac Surg, 2016, 5(2): 151-153. DOI:10.21037/acs.2016.03.02.
[6]	Cui F, Liu J, Li S, et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively[J]. J Thorac Dis, 2016, 8(8): 2226-2232. DOI:10.21037/jtd.2016.08.02.
[7]	Zheng Y, Mao M, Ji M, et al. Does a pulmonary rehabilitation based ERAS program (PREP) affect pulmonary complication incidence, pulmonary function and quality of life after lung cancer surgery? Study protocol for a multicenter randomized controlled trial[J]. BMC Pulm Med, 2020, 20(1): 44. DOI:10.1186/s12890-020-1073-6.
[8]	Wen Y, Jiang Y, Liang H, et al. Tubeless video-assisted thoracic surgery for lung cancer: is it ready for prime time?[J]. Future Oncol, 2020, 16(18): 1229-1234. DOI:10.2217/fon-2020-0278.
[9]	Gonzalez-Rivas D, Bonome C, Fieira E, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery?[J]. Eur J Cardiothorac Surg, 2016, 49(3): 721-731. DOI:10.1093/ejcts/ezv136.
[10]	Feng SH, Yang ST. The new 8th TNM staging system of lung cancer and its potential imaging interpretation pitfalls and limitations with CT image demonstrations[J]. Diagn Interv Radiol, 2019, 25(4): 270-279. DOI:10.5152/dir.2019.18458.
[11]	He J, Liu J, Zhu C, et al. Expert consensus on tubeless video-assisted thoracoscopic surgery (Guangzhou)[J]. J Thorac Dis, 2019, 11(10): 4101-4108. DOI:10.21037/jtd.2019.10.04.
[12]	Gálvez C, Bolufer S, Gálvez E, et al. Anatomic Segmentectomy in Nonintubated Video-Assisted Thoracoscopic Surgery[J]. Thorac Surg Clin, 2020, 30(1): 61-72. DOI:10.1016/j.thorsurg.2019.09.003.
[13]	车国卫. 加速康复外科——临床应用加减之间？[J]. 中国肺癌杂志, 2019, 22(11): 681-686. DOI:10.3779/j.issn.1009-3419.2019.11.01.
	Che GW. Proper selection of enhanced recovery after surgery programs between the medical service and medical intervence - Is it time to do?[J]. Chin J Lung Cancer, 2019, 22(11): 681-686. DOI:10.3779/j.issn.1009-3419.2019.11.01.
[14]	李莉, 杨福娜, 邹其云, 等. 快速康复外科理念配合心理支持对肺癌患者围手术期心理状态、术后疼痛及生活质量的影响[J]. 中国健康心理学杂志, 2019(10): 1483-1487. DOI:10.13342/j.cnki.cjhp.2019.10.011.
[15]	Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review[J]. JAMA Surg, 2017, 152(3): 292-298. DOI:10.1001/jamasurg.2016.4952.
[16]	Batchelor T, Ljungqvist O. A surgical perspective of ERAS guidelines in thoracic surgery[J]. Curr Opin Anaesthesiol, 2019, 32(1): 17-22. DOI:10.1097/ACO.0000000000000685.
[17]	Li S, Ai Q, Liang H, et al. Non-intubated robotic-assisted thoracic surgery for tracheal/airway resection and reconstruction: technique description and preliminary results[J]. Ann Surg, 2021, DOI:10.1097/SLA.0000000000004887.
[18]	Chen F, Wang G. Enhanced recovery after surgery for lung cancer patients[J]. Open Med (Wars), 2020, 15: 198-203. DOI:10.1515/med-2020-0029.
[19]	王武, 谢金标, 林建新, 等. 喉罩通气非气管插管麻醉对肺癌行胸腔镜手术患者临床疗效的影响[J]. 癌症进展, 2021, 19(2): 160-163. DOI:10.11877/j.issn.1672-1535.2021.19.02.13.
	Wang W, Xie JB, Lin JX, et al. Effect of non-tracheal intubation anesthesia of laryngeal mask airway in patients undergoing thoracoscopic surgery for lung cancer[J]. Oncology Progress, 2021, 19(2): 160-163. DOI:10.11877/j.issn.1672-1535.2021.19.02.13.
[20]	钟云鹏, 何建行, 李树本. 无管化电视胸腔镜在肺癌手术中的应用[J]. 临床外科杂志, 2020, 28(7): 624-626. DOI:10.3969/j.issn.1005-6483.2020.07.008.