胸椎旁神经阻滞联合喉罩全麻在肺大泡切除术中的应用

Application of thoracic paravertebral nerve block combined with laryngeal mask application in pulmonary bullae operation

中文关键词: 胸椎旁神经阻滞  胸腔镜  肺大泡切除术

英文关键词: Thoracic paravertebral nerve block  Thoracoscopic  Pulmonary bullae operation

中文摘要:

      
目的 评估超声引导下胸椎旁神经阻滞联合保留自主呼吸的喉罩全麻在胸腔镜下肺大泡切除术的安全性和有效性。
方法 选择择期行胸腔镜下行肺大泡切除术患者60例，男36例，女24例，年龄17～30岁，ASA Ⅰ或Ⅱ级，随机分为两组，每组30例。A组采用传统双腔支气管导管全麻，实现术中单肺通气。B组清醒时在超声引导下行胸椎旁神经阻滞，丙泊酚静脉诱导后置入喉罩，术中不使用肌松药，保留患者的自主呼吸，在自主呼吸状态下术侧肺因大气压和肺的弹性回缩塌陷。B组仅用七氟醚维持麻醉深度。术后两组患者均采用PCIA。记录术中SpO2最低值、PETCO2最大值；记录术野暴露情况评分、麻醉时间、手术时间、苏醒时间、术后住院时间及住院费用；观察术中有无呼吸抑制和咳嗽；观察术后有无恶心呕吐、咽部不适、声嘶发生。
结果 两组术中SpO2最低值、PETCO2最大值、术野暴露情况评分、麻醉时间、手术时间差异无统计学意义。B组术中无呼吸抑制。与A组比较，B组苏醒时间、术后住院时间明显缩短（P＜0.05），住院费用明显降低（P＜0.05），恶心呕吐、术后咽痛、声嘶发生率明显降低（P＜0.05）。
结论 超声引导下胸椎旁神经阻滞联合保留自主呼吸的喉罩全麻可安全用于胸腔镜下肺大泡切除术，且可加快患者术后康复。

英文摘要:

      
Objective To evaluate the feasibility and safety of ultrasound-guided thoracic paravertebral nerve block combined with spontaneous vreathing anesthesia with laryngeal mask in thoracoscopic resection of pulmonary bullae.
Methods Sixty patients undergoing thoracoscopic bullectomy, 36 males and 24 females, aged 17-30 years, ASA physical statusⅠor Ⅱ, were randomly divided into two groups, 30 cases in each group. In group A, conventional double-lumen endobronchial catheters were used to achieve single-lung ventilation during surgery. In group B, the thoracic paravertebral nerve block was guided by ultrasound and the laryngeal mask was placed after vein induction with propofol. Muscle relaxant was not used during the operation. The patient's spontaneous breathing was retained and only the sevoflurane was used to maintain the depth of anesthesia. Under the spontaneous breathing state, the operative lung collapses due to atmospheric pressure and elastic retraction of the lung. Postoperative PCIA was used in both groups. The lowest value of SpO2 during surgery, the maximum value of PETCO2, the operative field exposure score, anesthesia time, operation time, recovery time, postoperative hospital stay and hospitalization costs were recorded. The presence of respiratory depression and cough response in the operation and postoperative nausea and vomiting, throat discomfort, and hoarseness were observed.
Results There was no significant difference in the values of SpO2, PETCO2, surgical field exposure, anesthesia time and operation time between the two groups. There was no respiratory depression in group B. Compared with group A, awakening time and postoperative hospital stay were significantly shorter in group B, and hospitalization costs were significantly lower (P < 0.05). The incidence of nausea and vomiting, postoperative sore throat and hoarseness was significantly lower in group B than in group A (P < 0.05).
Conclusion Ultrasound guided thoracic paravertebral nerve block combined with spontaneous breathing anesthesia with laryngeal mask can be safely used in thoracoscopic resection of pulmonary bullae and can accelerate postoperative recovery.