保留自主呼吸非气管插管麻醉在中老年患者肺大疱切除术中的应用

目的探讨自主呼吸非气管插管麻醉方式在中老年患者肺大疱切除术中的临床应效果和安全性。 方法选取2017年2月至2018年2月在浙江医院行胸腔镜下肺大疱切除术的30例中老年患者，其中17例采用保留自主呼吸气管插管麻醉方式（气管插管麻醉组），13例采用保留自主呼吸非气管插管麻醉（非气管插管麻醉组）。观察记录并比较两组患者手术时间、术后疼痛评分（取第1、3天均值）、术后进食时间、术后下床活动时间、拔管时间及总住院时间等情况。两组间计量资料的比较采用t检验，计数资料的比较采用χ²检验。 结果所有患者均顺利完成手术，非气管插管组无中转插管情况，无中转开胸、无术后并发症发生等情况。非气管插管麻醉组仅手术时间较气管插管麻醉组略长（t=-1.751，P<0.05），进食时间、下地活动时间均较气管插管麻醉组明显缩短（t=9.995、7.256，P<0.05）；两组患者术后第1、3天疼痛评分、拔管时间、住院时间的差异均无统计学意义（t=3.009、2.314、2.992，P>0.05）。 结论对于在胸腔镜下行肺大疱切除的中老年患者，保留自主呼吸非气管插管麻醉方式具有术后恢复快、患者满意度高且痛苦小的优点，在严格掌握适应证和规范操作的前提下，该麻醉方式是安全可行的。

Application of non-endotracheal intubation anesthesia under self-sustaining breathing in pulmonary herpes resection in patients over 45 years old

ObjectiveTo explore the clinical effect and safety of the non-intubated anaesthetic in patients over 45 years old. MethodsFrom February 2017 to February 2018, 30 patients over 45 years old admitted to Zhejiang Hospital were selected. Among them, 17 patients were treated with endotracheal intubation anesthesia (group A) and 13 patients with non-endotracheal intubation anesthesia (group B). The operation time, postoperative pain score, postoperative feeding time, postoperative out-of-bed activity time, extubation time and total hospitalization time were observed and compared between the two groups. T test was used to compare the measurement data between the two groups, and χ² test was used to compare the count data. ResultsAll operations were completed successfully, and there was no transference intubation in group A, no conversion to thoracotomy and no postoperative complications. The operation time of group A was longer than that of group B (t=-1.751, P<0.05), the feeding time and underground activity time were significantly shorter than that in group B (t=9.995, 7.256, P<0.05). There was no significant difference in pain score, extubation time and hospitalization time between group A and group B (t=3.009, 2.314, 2.992, P>0.05). ConclusionFor middle-aged and elderly patients undergoing thoracoscopic bullosa removal, it has the advantages of fast recovery, high satisfaction and little pain to keep the self breathing and non endotracheal intubation anesthesia. Under the premise of strict indications and standardized operation, the anesthesia is safe and feasible.