剑突下入路与右胸肋间入路胸腔镜胸腺切除术效果比较  

Comparison of operative observation indexes of thoracoscopic thymectomy through the subxiphoid approach and the right intercostal approach

作　　者：马云霞 陈何伟 王美琳 MA Yunxia;CHEN Hewei;WANG Meilin(Operating Room,Shijiazhuang people’s Hospital,Hebei,Shijiazhuang 050011,China;不详)

机构地区：[1]河北省石家庄市人民医院手术室,050011 [2]河北省石家庄市人民医院麻醉科,050011

出　　处：《河北医药》2023年第13期2012-2015,共4页Hebei Medical Journal

基　　金：石家庄市科学技术研究与发展计划项目(编号:181201063)。

摘　　要：目的分析剑突下入路与右胸肋间入路胸腔镜胸腺切除术手术室的观察指标。方法选择2018年3月至2019年3月收治的胸腔镜胸腺切除手术患者40例,随机分为剑突下入路组(J组)和右胸肋间入路组(Y组),每组20例。比较2组患者气管插管一次成功率、气管插管时间、麻醉时间,患者术中血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、气道峰压(Pmax)、肺动脉顺应性(Cdyn)平均值以及2组手术时间、术中出血量、体位摆放时间、皮肤压红发生率,术后VAS评分,镇痛泵使用次数。结果J组气管插管一次成功率高、气管插管时间短、麻醉时间少,与Y组比较差异有统计学意义(P<0.05)。J组术中PaO_(2)、Cdyn高于Y组,PaCO_(2)、Pmax低于Y组,差异有统计学意义(P<0.05)。J组手术时间短,出血少,体位摆放时间短,与Y组比较差异有统计学意义(P<0.05)。J组术后VAS评分低,镇痛泵的使用次数少,与Y组比较差异有统计学意义(P<0.05)。结论剑突下入路胸腔镜胸腺切除术气管插管一次成功率高,气管插管时间短,麻醉时间少,术中PaO_(2)、Cdyn平均值更高,PaCO_(2)、Pmax平均值更低,手术时间短,出血量少,体位摆放简单,术后皮肤压红发生率低,护理并发症少,术后VAS评分低,对镇痛泵的需求也减小,值得推广应用。Objective To analyze the operative observation indexes of thoracoscopic thymectomy through the subxiphoid approach and the right intercostal approach.Methods From March 2018 to March 2019,a total of 40 patients undergoing thoracoscopic thymectomy were selected and randomly enrolled into two groups,including the subxiphoid approach group(group J,n=20)and the right intercostal approach group(group Y,n=20).The success rate of tracheal intubation,tracheal intubation time,anesthesia time,average values of intraoperative PaO_(2),PaCO_(2),Pmax and Cdyn,the operation time,the amount of intra-operative bleeding,the posture time,the incidence of skin redness,post-operative visual analog scale(VAS)score,and number of analgesic pump use were compared between the two groups.Results Compared with group Y,the success rate of tracheal intubation in group J was significantly higher,and tracheal intubation time and anesthesia time were shorter(P<0.05).During surgery,PaO_(2) and Cdyn in Group J were significantly higher than those in Group Y,while PaCO_(2) and Pmax were lower(P<0.05).Group J exhibited significantly shorter operation time,less bleeding,shorter posture time compared with those in Group Y(P<0.05).Meanwhile,post-operative VAS score was lower and the number of analgesic pump use was less in Group J compared with Group Y(P<0.05).Conclusion Compared with thoracoscopic thymectomy through the right intercostal approach,the subxiphoid approach has the advantages of highersuccess rate of tracheal intubation,shorter tracheal intubation time,less anesthesia time,higher average values of intraoperative PaO_(2) and Cdyn,lower average values of PaCO_(2) and Pmax,shorter operation time,lessbleeding,shorter posture time,lower incidence of post-operative skin redness,fewer nursing complications,lower post-operative VAS score andlower needs for analgesic pump,which is more worthy of promotion and application.

关 键 词：胸腔镜胸腺切除 麻醉时间 手术时间 出血量 血气指标 皮肤压红发生率 

分 类 号：R583[医药卫生—内分泌]