保留自主呼吸不插管麻醉在胸腔镜肺部手术中的应用  

Application of Anesthesia Keeping Spontaneous Breathing Without Intubation in Thoracoscopic Lung Surgery

作　　者：廖金庆 卢清旺 黄琦萍 王云利 颜景佳[3] Liao Jinqing;Lu Qingwang;Huang Qiping(不详;Department of Anesthesiology,Quanzhou First Affiliated Hospital of Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建省德化县中医院麻醉科,德化362500 [2]福建省晋江市医院麻醉科,晋江362200 [3]福建医科大学附属泉州第一医院麻醉科,泉州362000

出　　处：《中国微创外科杂志》2023年第1期3-7,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的观察保留自主呼吸不插管麻醉在胸腔镜肺部手术中的可行性。方法选择2022年1月~8月择期胸腔镜肺部手术80例,随机分为观察组(保留自主呼吸不插管组)和对照组(双腔支气管插管控制呼吸),每组40例。2组均在诱导前以0.5%罗哌卡因20 ml行手术侧胸椎旁神经阻滞,诱导时丙泊酚3~4μg/ml效应室浓度靶控输注(target-controlled infusion,TCI),静脉注射纳布啡0.6 mg/kg。观察组诱导时以小剂量肌松剂顺阿曲库铵0.0375~0.075 mg/kg静脉注射,诱导后置入双腔喉罩,静吸复合维持,诱导后麻醉过程不再用肌松药,同步间歇指令通气(SIMV)模式,尽快让自主呼吸恢复。对照组诱导时常规剂量肌松剂顺阿曲库铵0.15~0.3 mg/kg静脉注射,诱导后双腔气管插管,静吸复合维持,间隔30~45 min追加顺阿曲库铵2~3 mg,间歇正压通气(IPPV)模式。观察2组手术开始切皮时(T_(1))、手术开始后30 min(T_(2))、手术结束缝皮时(T_(3))、手术结束时(T_(4))、手术结束后15 min(T_(5))、手术结束后30 min(T_(6))6个时点的血流动力学变化和BIS值;T_(2)和T_(6)时点采血测定肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD);记录术中肺萎陷程度、术野暴露满意度。结果T_(1)、T_(2)时观察组收缩压、心率均高于对照组(P<0.05),T_(4)时低于对照组(P<0.05)。T_(2)和T_(6)时点AngⅡ观察组均明显低于对照组(P<0.05),2组PRA、ALD差异无统计学意义(P>0.05)。2组术侧肺萎陷程度、术野暴露满意程度比较差异均无统计学意义(P>0.05)。结论不插管保留自主呼吸麻醉可满足胸腔镜肺部手术操作需要,而且较双腔支气管插管麻醉血流动力学波动和应激反应更小。Objective To study the feasibility of anesthesia keeping spontaneous breathing without intubation in thoracoscopic lung surgery.Methods A total of 80 patients undergoing selective thoracoscopic pulmonary surgery from January to August 2022 were randomly divided into observation group(spontaneous breathing without intubation group)and control group(double-lumen bronchial intubation control breathing group),with 40 cases in each group.In both groups,preoperative thoracic paravertebral nerve block was administered with 0.5%ropivacaine 20 ml before induction,with target-controlled infusion(TCI)of propofol at 3-4μg/ml,followed by intravenous injection of nalbuphine at 0.6 mg/kg.In the observation group,a small dose of the muscle relaxant cisatracurium at 0.0375-0.075 mg/kg was injected intravenously during induction.After induction,a double lumen laryngeal mask was inserted,and the combination of intravenous aspiration was maintained.After induction,no muscle relaxants were used in the anesthesia process,and synchronous intermittent command ventilation(SIMV)mode was synchronized to restore the spontaneous respiration as soon as possible.In the control group,cisatracurium was injected at 0.15-0.3 mg/kg intravenously with conventional dose of muscle relaxant.After induction,double-lumen endotracheal intubation was performed,and the combination of intravenation was maintained.Cisatracurium 2-3 mg was added at intervals of 30-45 min,and intermittent positive pressure ventilation(IPPV)mode was adopted.Hemodynamic changes and BIS values of the two groups were observed at the beginning of the operation(T_(1)),30 min after the beginning of operation(T_(2)),when the skin was stitched before ending(T_(3)),at the end of the operation(T_(4)),15 min after the operation(T_(5)),and 30 min after the operation(T_(6)).Renin activity(PRA),angiotensin Ⅱ(AngⅡ)and aldosterone(ALD)were measured at T_(2)and T_(6)time points.The degree of lung collapse during the operation and the satisfaction of exposure of the operative field were reco

关 键 词：胸腔镜手术 保留自主呼吸麻醉 喉罩 双腔支气管插管 

分 类 号：R614[医药卫生—麻醉学]