非气管内插管麻醉监护下局部麻醉胸腔镜交感神经切断术治疗多汗症的随机对照试验  

Video-assisted Thoracic Surgery Sympathectomy under Monitored Anesthesia Care and Local Analgesia for the Treatment of Palmar Hyperhidrosis without Endotracheal Intubation: A Randomized Controlled Trial

作　　者：谢亮[1] 陈刚 王庆[2] 崔灿[2] 叶雄[1] 张冬坤[1] 周子浩[1] 唐继鸣[1] 贲晓松[1] 王刚[2] 林文梁[1] 毛宇宏 

机构地区：[1]广东省人民医院广东省医学科学院胸外科,广州510080 [2]广东省人民医院广东省医学科学院麻醉科,广州510080

出　　处：《中国胸心血管外科临床杂志》2014年第1期11-16,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的介绍多汗症快速康复外科治疗的新方法,并探讨麻醉监护下非气管内插管局部麻醉胸腔镜交感神经切断术治疗多汗症的可行性、安全性及有效性。方法纳入广东省人民医院124例中度以上多汗症患者,采用SPSS 18.0软件计算机生成随机序列,将患者分成非气管内插管局部麻醉组及气管内插管全身麻醉组,每组各62例,局部麻醉组男43例、女19例,年龄(22.25±6.22)岁;全身麻醉组男42例、女20例,年龄(23.98±6.67)岁。局部麻醉组不需气管内插管,仅予鼻导管或面罩吸氧,行麻醉监护;全身麻醉组常规气管内插管下完成手术,比较两组临床效果。结果所有患者均安全顺利完成手术。局部麻醉组无1例转为气管内插管全身麻醉。局部麻醉组和全身麻醉组的手术时间[(47.18±12.06)min vs.(39.33±13.21)min,P=0.002]、总操作时间[(84.52±22.56)min vs.(134.68±26.12)min,P=0.000]差异有统计学意义。两组出血量、术中脉搏血氧饱和度(SpO2)<95%例数(2例vs.0例),术后住院时间、术后代偿性多汗发生率(86.50%vs.89.00%),术后患者满意率(94.59%vs.95.12%)差异均无统计学意义;两组均无术中疼痛不适、手术并发症、术后复发发生。两组麻醉准备时间[(20.52±10.55)min vs.(36.47±12.16)min],术后清醒出手术室时间[(11.26±7.09)min vs.(59.39±19.89)min],住院费用[(6 376.86±746.00)元vs.(8 812.04±867.93)元]差异有统计学意义(P均为0.000)。局部麻醉组术后咽喉部不适等(0%vs.100%),术后监护时间(4 h vs.12 h),术后进食时间(2 h vs.6 h)均优于全身麻醉组。结论非气管内插管麻醉监护下局部麻醉胸腔镜双侧交感神经切断术安全可行,有效,避免了气管内插管全身麻醉的危害,更微创,是一种较好的治疗多汗症的快速康复外科方法。Objective To investigate the feasibility, safety and effectiveness of video-assisted thoracic surgery （VATS） sympathectomy under monitored anesthesia care （MAC） and local anesthesia （LA） without endotracheal intubation as a new fast track recovery surgical strategy for the treatment ofpalmar hyperhidrosis. Methods A total of 124 patients with intermediate or severe hyperhidrosis who were admitted to Guangdong General Hospital were enrolled in this study. With SPSS 18 random number generator, all the patients were divided into MAC q-LA group and general anesthesia （GA） group with 62 patients in each group. There were 43 males and 19 females in MAC ＋ LA group with their age of 22.25 ± 6.22 years, and 42 males and 20 females in GA group with their age of 23.98± 6.67 years. During the surgery, MAC q-LA group patients received MAC and oxygen via nasal tube or face mask instead of endotracheal intubation, and GA group pati- ents received GA, endotracheal intubation and controlled ventilation. Clinical outcomes were compared between the 2 groups. Results All the patients received their operations safely, None of MAC＋LA group patients received conversion to GA andcontrolled ventilation. There was statistical difference in operation time （47.18± 12.06 minutes vs. 39.33± 13.21 minutes, P=-0.002 ） and length of theatre stay 84.52± 22.56 minutes vs. 134.68 4- 26.12 minutes, P=0.000） between MAC ＋ LA and GA group patients. There was no statistical difference in blood loss, incidence of intraoperative SpO2 lower than 95% （ 2 patients vs. 0 patient）, postoperative hospital stay, incidence of postoperative compensatory sweating （ 86.5% vs. 89.0% ） and patient satisfaction rate （ 94.59% vs.95.12% ） between the 2 groups. No intraoperative pain, postoperative complication or symptom recurrence was observed in either group. There was statistical difference in anesthetic preparation time （20.52 4± 10.55 minutes vs. 36.47±12.16 minutes ）, duration between operation finish and returnin

关 键 词：多汗症 胸腔镜下胸交感神经切断术 麻醉监护 局部麻醉 快速康复外科 随机对照试验 

分 类 号：R655[医药卫生—外科学]