漏斗胸NUSS矫治术在非气管插管麻醉下实施的研究

发布时间：2018-01-26 21:47

本文关键词： 漏斗胸 NUSS 喉罩非气管内插管气管内插管　出处：《南方医科大学》2017年博士论文　论文类型：学位论文

【摘要】：背景漏斗胸是最常见的先天性胸廓畸形,占所有胸壁畸形的9 0%,最理想的治疗选择是外科手术。气管内插管全身麻醉下NUS S矫治术是目前国内外漏斗胸的主要治疗手段。非气管内插管麻醉具有创伤小、术后并发症少的优点,因此被越来越多地应用在胸部手术麻醉中。目的(1)探索漏斗胸NU S S矫治术在喉罩行非气管内插管麻醉下实施的安全性和可行性;(2)对比喉罩非气管内插管与气管内插管麻醉下漏斗胸NU S S矫治术的效果。方法(2)从20 1 5年7月至20 1 5年1 2月对符合纳入标准的3 0例漏斗胸患者在使用喉罩行非气管内插管全身麻醉下实施NUS S矫治术。收集临床数据并进行分析。(3)从2 0 1 5年1 0月至2 0 1 6年9月将符合标准的6 4例漏斗胸患者随机分为喉罩组和气管内插管组,分别在喉罩非气管内插管和气管内插管麻醉下实施漏斗胸NUSS矫治术。收集临床数据并进行分析。结果(1)所有患者均成功完成漏斗胸N U S S矫治术,平均手术时长为79.9 6±4 5.3 7分钟,平均失血量为8.1±9.3 0ml,平均术后住院时间为4.1 3 ±1.3 0天。血流动力学在整个手术过程中都维持稳定。2例患者术后出现恶心,1例患者出现喉咙痛。疼痛评分在术后第一日平均为3.5 ±1.1,随后逐渐下降。无中转为开放手术、胃食管反流、住院死亡病例。(2)喉罩组与气管内插管组对比,在年龄、性别、Haller指数、麻醉顺利程度、手术顺利程度、置入钢板数量、手术时长、失血量、手术相关并发症、住院时间、矫治效果、血流动力学、围手术期超敏C-反应蛋白、术后疼痛方面两组之间差异均无统计学意义,P0.0 5。所有患者均成功完成漏斗胸NUSS矫治术,无中转为开放手术、胃食管反流、住院死亡病例。喉罩组3例患者在麻醉医生3次尝失败后中转为气管内插管。两组均未发生术中气道装置移位。结论(1)漏斗胸NU S S矫治术可以在喉罩行非气管内插管全身麻醉下被安全、有效地实施。(2)漏斗胸NUS S矫治术可以在喉罩行非气管内插管和气管内插管两种麻醉方式下安全有效地完成,其手术过程、矫治结果、术后并发症不受这两种麻醉方式的影响,手术医生和麻醉医生可以根据自身的经验和患者的具体情况进行选择。
[Abstract]:Background the funnel chest is the most common congenital thoracic malformation, accounting for 9 0% of all chest wall deformities. The best choice of treatment is surgery. NUS S is the main treatment method of funnel chest at home and abroad under general anesthesia of endotracheal intubation. Non-endotracheal intubation anesthesia has little trauma. The advantages of less postoperative complications. Objective 1) to explore the safety and feasibility of NUS correction of funnel chest under non-tracheal intubation anesthesia in laryngeal mask. (2) to compare the effect of intratracheal intubation of larynx mask with that of endotracheal intubation under endotracheal intubation anesthesia. From July to December of 2015, 30 patients with funnel chest who met the inclusion criteria were treated with NUS under general anesthesia under non-tracheal intubation with laryngeal mask. S Orthodontics. Collection and analysis of clinical data. 3) from October 2005 to September 2006, 64 patients with funnel chest were randomly divided into laryngeal mask group and endotracheal intubation group. NUSS correction of funnel chest was performed under laryngeal mask non-tracheal intubation and endotracheal intubation respectively. Clinical data were collected and analyzed. All the patients were successfully treated with N U S S of funnel chest. The mean operative time was 79.96 卤45.37 minutes and the average blood loss was 8.1 卤9.30 ml. The mean postoperative hospitalization time was 4.13 卤1.30 days. The hemodynamics remained stable throughout the operation in 2 patients with postoperative nausea. One patient developed a sore throat. The average pain score was 3.5 卤1.1 on 1st, and then decreased gradually. There was no conversion to open surgery and gastroesophageal reflux. The laryngeal mask group was compared with the endotracheal intubation group in terms of age, sex, Haller index, anesthesia, surgical success, the number of plates placed, the length of operation, and the amount of blood lost. There was no significant difference between the two groups in terms of operative complications, hospital stay, curative effect, hemodynamics, perioperative hypersensitive C-reactive protein and postoperative pain. P0.05. all patients successfully completed funnel chest NUSS correction, no conversion to open surgery, gastroesophageal reflux. 3 patients in laryngeal mask group were converted to endotracheal intubation after three failed anaesthesiologists. There was no airway device shift during operation in both groups. The Nu S S correction of funnel chest can be safely performed under general anesthesia without endotracheal intubation in laryngeal mask. NUS S correction of funnel chest can be performed safely and effectively under the two anesthesia modes of laryngeal mask, non-tracheal intubation and endotracheal intubation. The postoperative complications are not affected by the two anesthetic methods, the surgeon and the anesthesiologist can choose according to their own experience and the patient's specific situation.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R655

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