胸腔镜肺大泡切除术非气管插管与传统全身麻醉方法比较  

Cost-effectiveness of different methods of anesthesia for thoracoscopic bulla resection:non-intubated and conventional general anesthesia

作　　者：徐青荣 沈江[1] 吴月红 蒋波[2] 张蕾[2] XU Qingrong;SHEN Jiang;WU Yuehong;JIANG Bo;ZHANG Lei(Department of Anesthesiology,the First People′s Hospital of Changzhou,Changzhou 221003,China)

机构地区：[1]苏州大学附属第三医院(常州市第一人民医院)麻醉科,江苏常州221003 [2]苏州大学附属第三医院(常州市第一人民医院)胸外科,江苏常州221003

出　　处：《实用医学杂志》2019年第3期420-423,共4页The Journal of Practical Medicine

基　　金：常州市卫生局重大科技项目(编号:ZD201206)

摘　　要：目的比较胸腔镜肺大泡切除术保留自主呼吸非气管插管全身麻醉与传统全身麻醉的费效。方法择期行胸腔镜肺大泡切除术患者60例,随机分为两组(n=30):传统全身麻醉组(T组)和非气管插管全身麻醉组(NT组)。T组常规全麻气管插管术后行单肺通气;NT组全身麻醉联合神经阻滞,保留自主呼吸。记录两组患者血气分析结果、术中及术后恢复情况、住院时间、术后48 h VAS评分及PCA次数。计算麻醉费用及住院总费用。结果与T组比较,NT组在关胸前和关胸后30 min时pH值降低,PCO2升高,关胸后30 min时氧合指数升高(P <0.05);与T组比较,NT组麻醉时间、定向力恢复时间和改良Aldrete评分≥9分时间、术后咽喉痛发生率、术后住院时间、术后6、12 h VAS评分及术后48 h PCA次数、麻醉费用及住院总费用均降低(P <0.05)。结论在充分考虑患者安全的前提下,与传统气管插管全身麻醉比较,非气管插管全身麻醉不仅有利于胸腔镜下肺大泡切除术患者术后转归,还可以改善费效。Objective To compare the cost-effectiveness of non-intubated general anesthesia with conventional general anesthesia for thoracoscopic bulla resection. Methods Sixty patients scheduled for elective thoracoscopic bulla resection,were divided into two groups(30 each)using a random number table:the conventional general anesthesia group(T group)and the non-intubated general anesthesia group(NT group). Patients in group T were induced with conventional general anesthetic,single-lung ventilated after intubation with double-lumen bronchial catheters. Patients in group NT were induced with general anesthesia combined nerve block,and spontaneous breathings were retained. The results of blood gas analysis,anesthesia time,operation time,intraoperative blood loss, time for orientation recovery and modified Aldrete score ≥ 9 minutes were recorded. The intraoperative and postoperative complications,postoperative hospital stay time,VAS and PCA scores 48 h after operation were recorded. Calculate the cost of anesthesia and the total cost of hospitalization. Results Compared with T group,NT group had lower pH value and higher PCO2 at 30 min before and after the thoracic closure,oxygenation index in the NT group increased at 30 min after the thoracic closure(P < 0.05). Compared with T group,anesthesia time,time for orientation recovery and modified Aldrete score ≥ 9 minutes,incidence of postoperative sore throat,postoperative hospital stay time,VAS scores at 6,12 h and PCA at 48 h after the operation,anesthesia costs,and total hospitalization costs in the NT group were all reduced(P < 0.05). Conclusions Fully considering the safety,compared with the traditional tracheal intubation general anesthesia,non-intubation general anesthesia can not only promote postoperative outcomes but also improve the cost-effectiveness in the patients undergoing thoracoscopic bulla resection.

关 键 词：非气管插管全身麻醉 传统全身麻醉 肺大泡切除术 胸腔镜 肺通气 费用效益 

分 类 号：R614.2[医药卫生—麻醉学]