全凭静脉联合胸段硬膜外阻滞麻醉在胸腔镜手术中的应用

目的：探讨全凭静脉全麻联合胸段硬膜外阻滞方法在胸腔镜手术中的应用。方法：择期胸腔镜微创手术术中需单肺通气的患者196例,ASAⅠ-Ⅱ级,随机分为A、B两组：A组选择98例患者入室后先做T56椎间隙硬膜外腔穿刺,向上置管34cm;B组采用全凭静脉全麻。两组病例全麻诱导后用传统方法插入双腔支气管导管（doublelumen endobronciltube,DLT）,用纤维支气管镜（FOB）确定和调整导管的位置,术中采用全凭静脉全麻,记录生命体征等。结果：A组整个麻醉手术中血流动力学稳定,苏醒无痛,术后肺部并发症少,全凭静脉全麻联合硬膜外阻滞利于胸腔镜手术的开展。FOB检查能准确定位DLT位置。结论：胸腔镜手术中应用FOB检查定位DLT位置是单肺通气能否顺利进行的关键,全凭静脉全麻联合硬膜外阻滞一种安全有效的麻醉方法,合理应用更有利于胸腔镜手术患者的肺功能恢复。

To Investigate the Method of Combined Total Intravenous Anesthesia and Thoracic Epidural Anesthesia in Video-assisted Thoracoscopic Surgery

Objective：To investigate the method of combined total intravenous anesthesia and thoracic epidural anesthesia in video-assisted thoracoscopic surgery.Method：To selecte minimally invasive video-assisted thoracoscopic surgery during one-lung ventilation to be 196 cases of patients,ASAⅠ～Ⅱ grade,were randomly divided into A,B group,A group of 98 cases of patients who choose to do after the break-T5～6 vertebral epidural space cavity puncture,catheter upward 3～4 cm.Group B total intravenous anesthesia.Two groups of patients after anesthesia induction using traditional methods to insert double-lumen endobronchial tube（double-lumen endobronciltube,DLT）,using fiberoptic bronchoscopy（FOB）to determine and adjust the catheter position during the use of total intravenous anesthesia,recording vital signs and so on.Results：A group of results in the entire anesthesia hemodynamic stability,and to wake up pain-free,less postoperative pulmonary complications,total intravenous anesthesia combined with epidural block in favor of the development of video-assisted thoracoscopic surgery.FOB check DLT accurate location positioning.Conclusion：Application of video-assisted thoracoscopic surgery DLT positioning FOB check the location of one-lung ventilation is the key to success,total intravenous anesthesia combined with epidural block anesthesia a safe and effective way to more rational use of video-assisted thoracoscopic surgery patients to restore lung function.