Liu Zhenhai, Ren Shengjie, Liu Ning, Luo Yanhua
Department of Anesthesiology, Weifang People's Hospital, Weifang, China.
School of Anesthesiology, Weifang Medical University, Weifang, China.
Front Med (Lausanne). 2023 May 15;10:1175437. doi: 10.3389/fmed.2023.1175437. eCollection 2023.
In recent years, video-assisted thoracic surgery (VATS) has become increasingly widespread. However, the implementation of VATS requires the assistance with lung isolation techniques. Spontaneous breathing with laryngeal masks is also increasingly used in VATS. However, evidence on the characteristics of intubated anesthesia is insufficient.
This study aimed to explore whether intubation-free anesthesia has more advantages than other intubation methods in the clinical setting.
Patients with lung tumors who underwent VATS in our hospital between June 2022 and October 2022 were included in the study. Perioperative data of patients, including basic information, intraoperative hemodynamic changes, postoperative inflammatory indicators, and adverse reactions were obtained through the electronic medical record system. According to the protocol of airway management during anesthesia, participants were divided into the following groups: laryngeal mask with spontaneous breathing group (LMSB group), laryngeal mask combined with bronchial blocker group (LM + BB group), double-lumen tube group (DLT group), and tracheal tube combined with bronchial blocker group (TT + BB group). All data were analyzed using SPSS 25.0 software.
At baseline, patients in the LMSB and LM + BB groups had a lower body weight ( = 0.024). Systolic blood pressure (SBP), diastolic BP (DBP), and heart rate (HR) were significantly higher in the DLT group than in the non-intubated group during surgery (SBP: T1 = 0.048, T4 = 0.021, T5 ≤ 0.001, T6 ≤ 0.001, T7 = 0.004; DBP: T5 ≤ 0.001, T6 ≤ 0.001, T7 ≤ 0.001; HR: T1 = 0.021, T6 ≤ 0.001, T7 = 0.007, T8 ≤ 0.001). The input fluid ( = 0.009), urine output ( = 0.010), surgery duration ( = 0.035), and procalcitonin levels ( = 0.024) of the DLT group were also significantly higher than those of the other groups. The recovery duration of the LMSB group was significantly longer ( = 0.003) and the incidence of postoperative adverse reactions, mainly atelectasis, was higher ( = 0.012) than those of the other groups.
Although the intubation-free anesthesia has less stimulation during operation and less postoperative inflammatory response, it has obvious adverse reactions after operation, which may be not the best anesthesia scheme for radical resection of lung cancer in VATS.
https://www.chictr.org.cn/showproj.html?proj=182767, identifier ChiCTR2200066180.
近年来，电视辅助胸腔镜手术（VATS）越来越普及。然而，VATS的实施需要肺隔离技术的辅助。喉罩自主呼吸在VATS中也越来越常用。然而，关于插管麻醉特点的证据不足。
本研究旨在探讨在临床环境中，非插管麻醉是否比其他插管方法具有更多优势。
纳入2022年6月至2022年10月在我院接受VATS的肺肿瘤患者。通过电子病历系统获取患者围手术期数据，包括基本信息、术中血流动力学变化、术后炎症指标和不良反应。根据麻醉期间气道管理方案，将参与者分为以下几组：喉罩自主呼吸组（LMSB组）、喉罩联合支气管封堵器组（LM + BB组）、双腔气管导管组（DLT组）和气管导管联合支气管封堵器组（TT + BB组）。所有数据使用SPSS 25.0软件进行分析。
基线时，LMSB组和LM + BB组患者体重较低（P = 0.024）。手术期间，DLT组的收缩压（SBP）、舒张压（DBP）和心率（HR）显著高于非插管组（SBP：T1，P = 0.048；T4，P = 0.021；T5，P≤0.001；T6，P≤0.001；T7，P = 0.004；DBP：T5，P≤0.001；T6，P≤0.001；T7，P≤0.001；HR：T1，P = 0.021；T6，P≤0.001；T7，P = 0.007；T8，P≤0.001）。DLT组的输入液体量（P = 0.009）、尿量（P = 0.010）、手术时间（P = 0.035）和降钙素原水平（P = 0.024）也显著高于其他组。LMSB组的恢复时间显著更长（P = 0.003），术后不良反应发生率，主要是肺不张，高于其他组（P = 0.012）。
尽管非插管麻醉术中刺激较小，术后炎症反应较轻，但术后有明显不良反应，可能不是VATS肺癌根治术的最佳麻醉方案。
https://www.chictr.org.cn/showproj.html?proj=182767，标识符ChiCTR2200066180 。
