喉罩全麻下单孔胸腔镜不留置胸管在胸部手术中的应用  

Application of laryngeal mask anesthesia without using chest drainage tube after single-port thoracoscopy surgery

作　　者：戴天阳 蒲江涛 何开明 胡智 徐涛 宋琦 吴云飞 Dai Tianyang Pu Jiangtao He Kaiming Hu Zhi Xu Tao Song Qi Wu Yunfei(Department of Thoracic Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichua)

机构地区：[1]西南医科大学附属医院胸心外科,四川泸州646000

出　　处：《泸州医学院学报》2016年第6期509-511,共3页Journal of Luzhou Medical College

摘　　要：目的:探讨喉罩全麻单孔胸腔镜胸部手术后不留置胸腔引流管的临床可行性和安全性。方法:对25例患者进行喉罩全麻单孔胸腔镜下胸部手术,且术后未留置胸腔引流管的的临床资料进行回顾性分析。观察指标:喉罩插管完成时间、手术时间、术中出血量、术后并发症(气胸、血胸、皮下气肿、肺炎、切口感染、咽喉部、胃肠道并发症)、疼痛评分、住院时间、切口Ⅰ级愈合率等。结果:本组资料回顾显示25例无1例中转行开胸手术,喉罩插管完成时间(1.9±0.2)min;手术时间(31.6±10.2)min;术中出血量(15.5±1.0)m L;术后清醒时间(0.2±0.1)h,胸壁感觉异常48%;胸腔积液28%;咽喉不适12%;胸腔积气16%;皮下气肿8%;术后住院时间(3.1±1.8)d;术后0、1和2 d Wong-Baker评分分别为2.6、2.2和1.5。结论:喉罩全麻单孔胸腔镜下行胸部手术后不留置胸腔引流管,若术前严格掌握手术指征,术后疼痛明显减轻,术后感染等并发症明显减少,恢复周期缩短。Objective： To investigate the clinical feasibility and safety of using laryngeal mask anesthesia single hole thoracoscopy in thoracic surgery without using drainage tube post thoracic surgery. Methods： The clinical data of 25 patients with laryngeal mask anesthesia single port thoracoscopy in thoracic surgery without using postoperative drainage tube were retrospectively analyzed. The variables used are： duration of LMA, operation time, intraoperative bleeding volume, postoperative complications （pneumothorax, thoracic blood, subcutaneous emphysema, pneumonia, wound infection, throat and gastrointestinal tract complications）, pain score, hospitalization time, incision primary healing rate. Results： The review shows that none of the 25 cases were switched to open chest surgery, the average intraoperative bleeding volume was （15.5 ± 1.0） mL, laryngeal mask insertion completion time was （1.9 ± 0.2） min, operation time was （31.6 ± 10.2） h, postoperative awake time was （0.2 ± 0.1 ） h, postoperative hospitalization time was （3.1± 1.8） d, and Wong Baker scores on postoperative day 0,1 and 2 were 2.6,2.2 and 1.5 respectively. About 48 % felt chest wall abnormal,28 % had pleural effusion,16 % had thorax pneumatosis, 12 % had throat discomfort,and 8 % had subcutaneous emphysema. Conclusion： Using laryngeal mask airway general anesthesia with a single hole in the chest surgery without using postoperative thoracic drainage tube, if criterions for the surgery are strictly followed, the method may significantly reduce postoperative pain, postoperative infection and other complications, and the recovery cycle is short.

关 键 词：单孔胸腔镜 喉罩全麻 胸腔引流管 

分 类 号：R459.4[医药卫生—治疗学]