非气管插管胸腔镜下肺癌手术的临床应用  

Thoracoscopelungcancer resection with non tracheal intubation anesthesia

作　　者：王继云[1] 李婷[2] 邹伟[1] 李万刚[1] 刘天伟[1] 田浩印 刘本刚[1] 张建伟[1] Ji-yun Wang;Ting Li;Wei Zou;Wan-gang Li;Tian-wei Liu;Hao-yin Tian;Ben-gang Liu;Jian-wei Zhang(Department of Thoracic Surgery, Central Hospital of Chinese National Petroleum Corporation,Langfang, Hebei 065000, China;Department of Internal Medicine, Langfang Health Vocational College, Langfang, Hebei 065000, China)

机构地区：[1]中国石油天然气集团公司中心医院胸外科,河北廊坊065000 [2]廊坊卫生职业学院内科教研室,河北廊坊065000

出　　处：《中国内镜杂志》2017年第8期7-12,共6页China Journal of Endoscopy

基　　金：河北省省级科技计划-社会科技事业及医疗卫生技术专项(No:16277737D)

摘　　要：目的评估非气管插管麻醉下胸腔镜肺癌手术的可行性和安全性。方法实验组与对照组各20例周围型肺癌患者。实验组采用喉罩通气麻醉、对照组采用气管插管麻醉行胸腔镜下肺部手术,监测并记录各组诱导前(T0)、诱导插管时(T1)、手术实施时(T2)和苏醒拔管时(T3)患者的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、心电图(ECG)、脉搏血氧饱和度(Sp O2)、呼末二氧化碳分压(PETCO2)、中心静脉压、有创动脉血压及血糖指标,并记录患者术后的相关并发症,如有无咽痛、声音嘶哑和恶心等。结果喉罩组患者麻醉过程中对心血管系统刺激小,术后进食、排气、下床活动时间、平均住院日缩短,住院费用降低,咽部、呼吸及心血管系统并发症少于插管组。结论喉罩通气静脉麻醉配合胸内迷走神经阻滞在胸腔镜肺叶切除术中操作简易、安全性好、无插管相关并发症及单肺通气肺部损伤,符合手术-麻醉整体微创发展的理念,值得临床推广。Objective To evaluate the feasibility and safety of thoracoscopic lung cancer surgery under nontrachealintubation anesthesia.Methods Twenty patients with peripheral lung cancer were enrolled in experimentalgroup and control group.Then monitored and recorded Systolic pressure(SBP),diastolic pressure(DBP),meanarterial pressure(MAP),heart rate(HR),electrocardiogram(ECG),heart rate(HR),Oxygen saturation(SpO2),Finalmoisture CO2partial pressure(PETCO2),central venous pressure,invasive arterial blood pressure and blood glucoseand the related complications like sore throat,hoarse voice,nausea and so onin such time points:before induction(T0),induction of intubation(T1),operation(T2),and sudden removal(T3)of the two groups.Results The laryngealmask group was given a smaller stimulus to the cardiovascular system during anesthesia.The time of feeding,theexhaust,the time of getting out of bed,the average hospitalization day,the reduction of hospitalization expenses,pharynx,respiratory and cardiovascular complications were shorter and less than intubation group.Conclusion Thelaryngeal mask ventilation intravenous anesthesia with thoracic vagal nerve block in the thoracoscopic lobectomy is simple,safe,no intubation-related complications and single lung ventilation lung injury,in line with surgery-anesthesia overall minimally invasive development concept,worthy of clinical promotion.

关 键 词：喉罩 气管内插管 胸腔镜 肺癌手术 

分 类 号：R619[医药卫生—外科学]