麻醉学监护下的局部麻醉胸腔镜胸交感神经阻断术114例  

Thoracoscopic sympathetic nerve blocking under local anesthesia with MAC:114 cases report

作　　者：郭绍红[1,2] 王晶晶[3,2] 

机构地区：[1]南京明基医院普通外科 [2]南京医科大学附属医院,江苏南京210019 [3]南京明基医院国际医疗中心心理门诊

出　　处：《中国内镜杂志》2012年第1期21-25,共5页China Journal of Endoscopy

基　　金：浙江省医药卫生科学研究基金计划项目(No.2007B219)

摘　　要：目的大样本研究麻醉学监护下的局麻一期双侧胸腔镜胸交感神经阻断术的优缺点。方法用于回顾性研究的患者共有205例,其中采用麻醉学监护下的局部浸润麻醉的共有114例(局麻组),采用单腔管插管全麻的共有91例(全麻组)。局麻组用0.5%利多卡因+0.0625%布比卡因浸润麻醉每个手术切口,术中使用瑞芬太尼辅助镇痛,麻醉学全程监护(MAC)。每侧切2个长约7mm的皮肤切口。穿入穿刺套管,进行常规的胸腔镜胸交感神经阻断术。结果局麻组患者整个手术过程中神智清醒,完全自主呼吸。局麻组和全麻组的入手术室至手术开始时间分别为(31.18±10.84)和(35.49±10.22)min(P<0.01);手术时间分别为(60.79±12.77)和(44.67±13.06)min(P<0.001);术毕至出手术室时间分别为(7.83±4.23)和(24.40±8.78)min(P<0.001);进出手术室时间分别为(100.32±17.34)和(104.34±17.45)min(P>0.05)。住院日两组分别为(3.48±0.91)和(3.80±0.81)d(P<0.01),局麻组和全麻组的住院费分别为(6382.41±935.91)和(7010.91±1009.83)元(P<0.001);麻醉药物费用分别为(168.72±59.29)和(534.54±121.46)元(P<0.001);麻醉费分别为(438.07±99.03)和(353.85±46.09)元(P<0.001);麻醉材料费分别为(32.64±54.99)和(225.23±82.23)元(P<0.001);麻醉总费用分别为(639.95±147.05)和(1111.54±139.75)元(P<0.001)。结论一期双侧胸腔镜胸交感神经阻断术可以在瑞芬太尼强化的局部浸润麻下完成,虽然手术时间延长,但显著缩短了手术前的准备和手术后的时间。与全麻手术相比,消除了全身麻醉的各种风险,手术安全、更为微创、显著减少了总费用、麻醉药物费用和麻醉材料费用、术后恢复加快、住院日显著缩短。[Objective] To investigate the advantages and disadvantages of the operation of one stage bilateral thoracoscopic sympathetic blocking（OSBTSB） under local infiltration anesthesia and spontaneous breathing with monitored anesthesia care（MAC） in large population.[Methods] Two hundred and five patients of hyperhidrosis or facial blushing were involved in this retrospective study.The methods of general anesthesia（GA） or local infiltration anesthesia（LIA） were chosen by patients before operation.The number of patients choosing local infiltration anesthesia with MAC for OSBTSB was 114 with the ages between 17 to 54 years（local anesthesia group-LAG） and the number of patients choosing single lumen tracheal intubation general anesthesia for OSBTSB was 91 with the ages between 16 to 58 years（general anesthesia group--GAG）.In the LAG,the LIA of each of the four incisions was made by injecting 10mL of 1% lidocaine and 0.0625% bupivacaine.During the course of surgery,remifentanil was used to assist the analgesic effect and vital signs were continuously monitored as MAC.There were two 7mm length skin incision at each side,penetrating the puncture cannula,and OSBTSB were performed according to the rout method same as which under the GA then.[Result] All the patients in LAG were consciousness and breathed spontaneously during the operation.The times from entering operation room to the beginning of the operation were（31.18±10.84） min for LAG and（35.49±10.22） min for GAG（P 0.01）.The operation time were（60.79±12.77） min for LAG and（44.67±13.06） min for GAG（P 0.001）.The time between finishing of the operation and getting out of operation room were（7.83±4.23） min for LAG and（24.40±8.78） min for GAG（P 0.001）.The time between entering and getting out of the operation room were（100.32±17.34） min for LAG and（104.34±17.45）min for GAG（P 0.05）.The hospitalization days were（3.48±0.91） days for LAG and（3.80±0.81） days for GAG（P 0.01）.The cost of hos

关 键 词：胸腔镜 胸交感神经 局部浸润麻醉 颜面潮红 多汗症 麻醉学监护 

分 类 号：R651.3[医药卫生—外科学]