非插管自主通气与插管机械通气麻醉在胸腔镜手术中的围手术期并发症和术者工作量评估方面的比较：一项前瞻性随机对照研究。
Nonintubated spontaneous ventilation versus intubated mechanical ventilation anesthesia for video-assisted thoracic surgery in terms of perioperative complications and practitioners' workload assessments: a pilot randomized control study.
机构信息
Department of Anesthesiology, Jining No. 1 People's Hospital, No. 6 Jiankang Road, Rencheng District, Jining, 272011, China.
Department of Thoracic Surgery, Jining No. 1 People's Hospital, No. 6 Jiankang Road, Rencheng District, Jining, 272011, China.
出版信息
BMC Anesthesiol. 2024 Mar 12;24(1):99. doi: 10.1186/s12871-024-02481-1.
BACKGROUND
The use of nonintubated video-assisted thoracoscopic surgery (NI-VATS) has been increasingly reported to yield favourable outcomes. However, this technology has not been routinely used because its advantages and safety have not been fully confirmed. The aim of this study was to assess the safety and feasibility of nonintubated spontaneous ventilation (NI-SV) anesthesia compared to intubated mechanical ventilation (I-MV) anesthesia in VATS by evaluating of perioperative complications and practitioners' workloads.
METHODS
Patients who underwent uniportal VATS were randomly assigned at a 1:1 ratio to receive NI-SV or I-MV anesthesia. The primary outcome was the occurrence of intraoperative airway intervention events, including transient MV, conversion to intubation and repositioning of the double-lumen tube. The secondary outcomes included perioperative complications and modified National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores from anesthesiologists and surgeons.
RESULTS
Thirty-five patients in each group were enrolled in the intention-to-treat analysis. The incidence of intraoperative airway intervention events was greater in the NI-SV group than in the I-MV group (12 [34.3%] vs. 3 [8.6%]; OR = 0.180; 95% CI = 0.045-0.710; p = 0.009). No significant difference was found in the postoperative pulmonary complications between the groups (p > 0.05). The median of the anesthesiologists' overall NASA-TLX score was 37.5 (29-52) when administering the NI-SV, which was greater than the 25 (19-34.5) when the I-MV was administered (p < 0.001). The surgeons' overall NASA-TLX score was comparable between the two ventilation strategies (28 [21-38.5] vs. 27 [20.5-38.5], p = 0.814).
CONCLUSION
The NI-SV anesthesia was feasible for VATS in the selected patients, with a greater incidence of intraoperative airway intervention events than I-MV anesthesia, and with more surgical effort required by anesthesiologists.
TRIAL REGISTRATION
Chinese Clinical Trial Registry, ChiCTR2200055427. https://www.chictr.org.cn/showproj.html?proj=147872 was registered on January 09, 2022.
背景
非插管视频辅助胸腔镜手术（NI-VATS）的应用已被越来越多地报道为产生有利的结果。然而，由于其优势和安全性尚未得到充分证实，该技术尚未常规使用。本研究的目的是通过评估围手术期并发症和从业者的工作量，评估非插管自主通气（NI-SV）麻醉与插管机械通气（I-MV）麻醉在 VATS 中的安全性和可行性。
方法
接受单孔 VATS 的患者以 1:1 的比例随机分配接受 NI-SV 或 I-MV 麻醉。主要结局是术中气道干预事件的发生，包括短暂 MV、转为插管和双腔管重新定位。次要结局包括围手术期并发症和麻醉师和外科医生的改良国家航空航天局任务负荷指数（NASA-TLX）评分。
结果
每组 35 例患者纳入意向治疗分析。NI-SV 组术中气道干预事件的发生率高于 I-MV 组（12[34.3%] vs. 3[8.6%]；OR=0.180；95%CI=0.045-0.710；p=0.009）。两组术后肺部并发症无显著差异（p>0.05）。行 NI-SV 时，麻醉师总体 NASA-TLX 评分为中位数 37.5（29-52），行 I-MV 时为 25（19-34.5）（p<0.001）。两种通气策略下，外科医生的总体 NASA-TLX 评分无差异（28[21-38.5] vs. 27[20.5-38.5]，p=0.814）。
结论
在选定的患者中，NI-SV 麻醉可用于 VATS，其术中气道干预事件的发生率高于 I-MV 麻醉，麻醉师需要更多的手术努力。
试验注册
中国临床试验注册中心，ChiCTR2200055427。https://www.chictr.org.cn/showproj.html？proj=147872 于 2022 年 1 月 9 日注册。
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