自主呼吸胸腔麻醉与双腔气管导管麻醉对非小细胞肺癌手术患者术后持续咳嗽的影响

【目的】探讨自主呼吸胸腔麻醉与双腔气管导管(DLT)麻醉对非小细胞肺癌(NSCLC)患者肺部术后持续咳嗽(CAP)的影响。【方法】选取2012年2月至2017年5月在本院手术治疗的NSCLC患者482例。根据麻醉方式将患者分为双腔气管导管麻醉组(T组,n=255)和自主呼吸胸腔麻醉组(S组,n=227),其中S组进一步分为静脉复合肋间神经阻滞麻醉组(SB组,n=93)和复合硬膜外麻醉组(SE组,n=134)。记录患者在胸腔镜手术后第一天(T1)、第二天(T2)、第三天(T3)、第一个月(T4)、第三个月(T5)的咳嗷概率及Leicester咳啦问卷(LCQ)调查结果、视觉疼痛评分(VAS)和咳嗽症状评分。采用Logistic回归分析NSCLC患者肺部术后CAP的独立影响因素。【结果】三组患者术后CAP发生率均随时间延长而减少(P<0.05);SE组与SB组咳嗽发生率均明显低于T组(P<0.05),但SE组与SB组咳嗽发生率比较差异无统计学意义(P>0.05)。术后,T组患者咳嗽症状评分及VAS评分高于SE组、SB组(P<0.05),T组患者LCQ评分明显低于SE组、SB组,其差异均有统计学意义(P<0.05);但S E组及SB组患者咳嗽症状评分、VAS评分及LCQ评分比较差异均无统计学意义(P>0.05)。多因素分析显示:年龄、吸烟史、气管树周围淋巴结、麻醉时间、麻醉方式是术后CAP发生的危险因素。【结论】肺部手术麻醉方式与术后CAP存在一定的相关性,自主呼吸麻醉能显著降低术后CAP的发生率,提高患者术后生活质量,年龄、吸烟史、气管树周围淋巴结、麻醉时间、麻醉方式是术后CAP发生的危险因素,临床应根据危险因素采取相应的措施。

Effect of Spontaneous Respiratory Thoracic Anesthesia and Double Lumen Tracheal Catheter Anesthesia on Persistent Cough after Pulmonary Resection in patients with Non-small Lung Cancer

【Objective】To investigate the effects of spontaneous respiratory thoracic anesthesia and double lumen tracheal(DLT)catheter anesthesia on persistent cough after pulmonary resection(CAP)in patients with non-small cell lung cancer(NSCLC).【Methods】A total of 482 patients with NSCLC who underwent surgery from February 2012 to May 2017 were enrolled.Patients were divided into the double-lumen tracheal catheter anesthesia group(T group,n=255)and spontaneous respiratory thoracic anesthesia group(S group,n=227)according to the anesthesia method.The S group was further divided into two sub-groups;intravenous intercostal nerve block anesthesia group(SB group,n=93)and intravenous epidural anesthesia group(SE group,n=134).The cough probabilities of the patient on the first day(T1),the second day(T2),the third day(T3),the first month(T4),and the third month(T 5)after thoracoscopic surgery were recorded.Leicester cough questionnaire(LCQ)survey results,visual analogue score(VAS)and cough symptom scores were measured as well.Logistic regression was used to analyze the independent influencing factors of persistent cough after pulmonary resection(CAP)in patien ts.【Results】After operation,the incidence of cough in the three groups decreased with time(P<0.05).The incidence of cough in the SE group and the SB group was significantly lower than that in the T group(P<0.05).There was no significant difference in the incidence of cough between the SE group and the SB group(P>0.05).After operation,the cough symptom score and VAS score in the T group were higher than those in the SE group and the SB group(P<0.05).The LCQ scores of patients in the T group were significantly lower than those in the SE group and the SB group;and the difference was statistically significant(P<0.05).However,there were no significant differences in cough symptoms scores,VAS scores,and LCQ scores between the SE group and the SB group(P>0.05).Multivariate analysis showed that age,smoking history,lymph nodes around the trachea,anesthesia time,and anesthesia mode were the risk factors for postoperative CAP.【Conclusion】There is a certain correlation between anesthesia of lung surgery and postoperative CAP.Spontaneous respiratory anesthesia can significantly reduce the incidence of postoperative CAP,improve postoperative recovery and postoperative quality of life.Since age,smoking history,lymph nodes around the tracheal tree,anesthesia time and anesthesia mode are risk factors for postoperative CAP,special attentions should be paid.