非气管插管麻醉下单孔胸腔镜治疗自发性气胸的临床应用

发布时间：2018-04-08 09:17

本文选题：非气管插管麻醉　切入点：单孔胸腔镜　出处：《中国微创外科杂志》2017年12期

【摘要】：目的探讨非气管插管麻醉下单孔胸腔镜肺大疱切除术治疗自发性气胸的可行性。方法 2015年1月~2017年2月,对40例自发性气胸行不插管静脉全麻复合椎旁神经阻滞下单孔胸腔镜肺大疱切除术。行T_4~T_5水平椎旁神经阻滞麻醉,舒芬太尼、丙泊酚诱导,意识消失后面罩呼吸机辅助通气,术中用右美托咪定、丙泊酚和瑞芬太尼靶控输注镇静镇痛,行单孔胸腔镜肺大疱切除术。结果 40例均顺利完成手术,无中转气管插管全麻。麻醉时间、麻醉苏醒时间以及在手术室的总时间分别为(24.0±5.0)min、(15.0±10.0)min和(71.0±25.5)min;手术时间(31.0±10.0)min。术中血气分析Pa CO2(45.0±5.0)mm Hg,术后12小时血气分析Pa CO2(40.0±6.0)mm Hg。术后胸腔闭式引流管留置时间(1.5±0.5)d,术后住院时间(2.0±1.0)d。无术中大出血、术后出血二次手术。术后漏气1例,负压吸引保守治疗治愈。术后随访(12±4)月,无气胸复发。结论单孔胸腔镜手术治疗气胸可以在非气管插管麻醉下完成,创伤小,尤其对气管插管有高危因素者,但需要麻醉师和术者完美配合,手术技能培训尤为重要。
[Abstract]:Objective to investigate the feasibility of single-hole thoracoscopic pneumonectomy for spontaneous pneumothorax under non-tracheal intubation anesthesia.Methods from January 2015 to February 2017, 40 cases of spontaneous pneumothorax were treated with single hole thoracoscopic pneumonectomy with no intubation and general anesthesia combined with paravertebral nerve block.T_4~T_5 level paravertebral nerve block anesthesia, sufentanil, propofol induction, ventilator assisted ventilation by mask after consciousness loss, sedation and analgesia with dexmetomidine, propofol and remifentanil were performed during the operation.Single-hole thoracoscopic pneumonectomy was performed.Results the operation was successfully completed in all 40 cases, and no general anesthesia was transferred to tracheal intubation.The anaesthesia time, anaesthesia recovery time and total time in the operating room were 24.0 卤5.0 10.0)min and 71.0 卤25.5 min, respectively, and the operative time was 31.0 卤10.0 min.Pa CO2(45.0 卤5.0)mm Hg was analyzed during operation and Pa CO2(40.0 卤6.0)mm Hg was analyzed 12 hours after operation.After operation, the time of retaining closed drainage tube in thoracic cavity was 1.5 卤0.5 days, and the postoperative hospitalization time was 2.0 卤1.0 days.No intraoperative bleeding, postoperative bleeding secondary surgery.Postoperative leakage of air in 1 case, negative pressure suction conservative treatment was cured.There was no recurrence of pneumothorax after follow-up for 12 卤4 months.Conclusion One-hole thoracoscopic surgery for pneumothorax can be performed under non-tracheal intubation anesthesia with less trauma, especially for those with high risk factors for tracheal intubation, but it is necessary for the anesthesiologist and the operator to cooperate perfectly, and the training of surgical skills is particularly important.
【作者单位】：南京医科大学附属常州第二人民医院心胸外科;南京医科大学附属常州第二人民医院麻醉科;
【分类号】：R655

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