硬膜外麻醉与气管插管全身麻醉对胸腔镜下肺大疱切除术患者术后恢复影响的随机对照试验  

Effect of epidural anesthesia vs.intubated anesthesia on the postoperative recovery of patients with thoracoscopic resection of lung bullae:A randomized controlled trial

作　　者：郭丰[1] 杨黎明[1] 郭君[1] 袁岚[1] 

机构地区：[1]上海中医药大学附属曙光医院麻醉科,上海201203

出　　处：《中国胸心血管外科临床杂志》2017年第9期706-710,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市卫生和计划生育委员会中医药科研基金资助(2014LP091B);上海市卫生和计划生育委员会科研计划项目(20154Y0111);上海市中医药事业发展三年行动计划项目(ZY3-CCCX-2-1003);上海市科学技术委员会科研计划项目(14401932600);国家自然科学基金项目(81503395)

摘　　要：目的比较硬膜外麻醉与气管插管全身麻醉对胸腔镜下肺大疱切除术患者术后恢复的影响。方法选择2014年12月至2015年12月我科择期行胸腔镜下单侧肺大疱切除术患者60例,其中男53例、女7例,年龄16~65岁。将患者随机分成两组:A组[硬膜外麻醉组,30例,其中男26例、女4例,平均年龄(25.0±5.8)岁]行胸段硬膜外阻滞复合胸内迷走神经阻滞;B组[全身麻醉组,30例,其中男27例、女3例,平均年龄(25.8±6.2)岁]全身麻醉经口双腔支气管插管,实施肺隔离。记录两组患者术后麻醉相关并发症的发生率和术后恢复情况。结果手术期间两组患者生命体征平稳、安全,两种麻醉方法均能满足手术要求。声带损伤和咽喉部疼痛例数B组多于A组,咽喉部疼痛发生率两组差异有统计学意义(P<0.01)。两组动脉血气显示A组患者在肺复张前二氧化碳分压要高于B组,差异有统计学意义(P<0.01)。A组患者术后疼痛视觉模拟评分低于B组,差异有统计学意义(P<0.05)。A组初次下床活动时间、初次进食时间、监护室滞留时间和术后住院时间均少于B组,差异有统计学意义(P<0.01)。结论硬膜外配合术中胸内迷走神经阻滞麻醉可以满足胸腔镜下肺大疱切除术的手术要求,并发症少,术后恢复快。Objective To compare the effects of epidural anesthesia with intubated anesthesia in the postoperative recovery of patients with thoracoscopic resection of lung bullae. Methods Sixty patients （53 males, 7 females, aged 16-65 years） undergoing thoracoscopic resection of unilateral pulmonary bullae in our hospital from December 2014 to December 2015 were randomly divided into two groups： a group A （epidural anesthesia group） received thoracic epidural block combined with intraoperative interthoracic vagus nerve block; a group B （general anesthesia group） received general anesthesia with double lumen endobronchial intubation and pulmonary sequestration. Postoperative anesthesia-related complications and postoperative recovery were recorded. Results Both of the two anesthesia methods could meet the requirements of operation. The patients with the vocal cord injury and sore throat in the group B were more than those in the group A. The difference was statistically significant in the incidence of sore throat （P〈0.01）. Arterial partial pressure of oxygen （PaO2） in the group A was significantly higher than that of group B before lung recruitment （P〈0.01）. Compared with the group B, the group A had less visual analogue scale （VAS） score （P〈0.05）, earlier activity and feeding, less postoperative ICU and hospital stay （P〈0.01）. Condusion Epidural anesthesia combined with intraoperative interthoracic vagus nerve block can meet thoracoscopic bullectomy surgery requirements with few complications and fast postoperative recovery.

关 键 词：硬膜外麻醉 胸腔镜 肺大疱 

分 类 号：R614[医药卫生—麻醉学]