不同方法对胸腔镜自主呼吸麻醉技术时抑制咳嗽反射的临床研究  

作　　者：吕机生[1] 邵大清 邵秀霞 丁洁羽 毛程远 徐鹏 

机构地区：[1]浙江省金华市人民医院(温州医科大学附属金华医院),321000 [2]浙江金华广福肿瘤医院,321000

出　　处：《浙江临床医学》2023年第8期1223-1225,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省金华市科技计划项目(2019-4-040)。

摘　　要：目的评价黏膜表面麻醉和胸内迷走神经阻滞对胸腔镜自主呼吸麻醉技术时抑制咳嗽反射的效果,为临床提供理论参考。方法回顾性分析选取自2017年1月至2021年3月行单侧胸腔镜手术且ASA分级为Ⅰ或Ⅱ级的90例患者临床资料。结果患者术中咳嗽反应比较,A组、B组咳嗽反应评估为优的例数均多于C组(P<0.05),A组、B组的优良率均大于C组(P<0.05),A、B组间比较无明显差异(P>0.05);各组患者的平均动脉压(MAP)、心率(HR)、呼吸(RR)、脉搏血氧饱和度(SpO_(2))、呼气末二氧化碳分压(P_(ET)CO_(2))均平稳在正常范围内波动,未见具有临床意义的事件发生。此外,与T0时比较,各组患者在T1、T4时MAP均下降(P<0.05),T1时下降更明显(P<0.01);T1~T4时HR均下降(P<0.01);T3时SpO_(2)均下降(P<0.01);T1~T3时RR均减慢(P<0.01);T3时P_(ET)CO_(2)均升高(P<0.01)。然而,各组间比较无明显差异(P>0.05);各组患者的血气分析指标与T0时比较,T3时pH值均下降(P<0.01),二氧化碳分压(PaCO_(2))均升高(P<0.01),各组间比较无明显差异(P>0.05);各组患者术野暴露程度比较无明显差异(P>0.05);各组患者术后恢复各指标的比较无明显差异(P>0.05)。结论在行胸腔镜自主呼吸麻醉技术时,加用气管黏膜表面麻醉或胸内迷走神经阻滞在抑制术中咳嗽反射的效果均比单纯使用右美托咪啶确切,形成了多模式镇咳,且对患者的循环、呼吸系统以及术野影响小,值得临床推广。Objective To evaluate the effect of tracheal and bronchial mucosal surface anesthesia and intrathoracic vagus nerve block on suppressing cough reflex during thoracoscopic spontaneous respiratory anesthesia.Methods 90 patients with ASA classification(gradeⅠorⅡ)who underwent unilateral thoracoscopic surgery from January 2017 to March 2021 were retrospectively analyzed.Results During the operation,the number of patients with excellent cough response in group A and B was more than that in group C,and the excellent and good rate in group A and B was greater than that in group C.MAP,HR,SpO_(2)and RR fluctuated steadily within the normal range in all groups.Additionally,compared with T0,MAP in all groups decreased at T1 and T4,and the decrease was more significant at T1.HR decreased from T1 to T4.SpO_(2)decreased in T3.RR decreased from T1 to T3.At T3,P_(ET)CO_(2)was increased.However,there was no difference among all groups.The blood gas analysis index of all groups was compared with that of T0,PH value was decreased at T3,PaCO_(2)was increased at T3,and there was no significant difference among all groups.Conclusion During thoracoscopic autonomous respiratory anesthesia,the addition of tracheal and bronchial mucosal surface anesthesia or intrathoracic vagal nerve block has more accurate effects on intraoperative cough reflex than dexmedetomidine alone.

关 键 词：表面麻醉 迷走神经阻滞 咳嗽反射 非气管插管 胸腔镜 

分 类 号：R614[医药卫生—麻醉学]