Turhan Özlem, Sivrikoz Nükhet, Duman Salih, Kara Murat, Sungur Zerrin
Department of Anesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Türkiye.
Department of Thoracic Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Türkiye.
Turk Gogus Kalp Damar Cerrahisi Derg. 2024 Jan 29;32(1):75-83. doi: 10.5606/tgkdc.dergisi.2024.25478. eCollection 2024 Jan.
The aim of this study was to evaluate the effect of awake video-assisted thoracoscopic surgery on postoperative pulmonary complications among patients with different risk scores using the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT).
Between January 2011 and August 2021, a total of 246 patients (158 males, 88 females; mean age: 59.1±13.6 years; range, 25 to 84 years) who underwent awake video-assisted thoracoscopic surgery were retrospectively analyzed. According to the ARISCAT scores, the patients with low and intermediate scores were included in Group L (n=173), while those with high scores (n=73) were included in Group H. Sedation protocol consisted of the combination of midazolam and fentanyl with propofol infusion, if necessary. Oxygen was delivered via face mask or nasal canula (2 to 5 L/min) maintaining an oxygen saturation of >95%, and analgesia was achieved with intercostal nerve block. Demographics, operative, and postoperative data of the patients, and pulmonary complications were evaluated.
Demographics, operative, and postoperative data were similar between the groups. Postoperative pulmonary complications were observed in 20 (27%) patients in Group H and 29 (17%) patients in Group L without statistically significant difference (p=0.056). Surgical approaches consisted of pleural procedures (n=194) and pulmonary resection (n=52). The incidence of pulmonary complications was significantly higher in the pulmonary resection compared to non-pulmonary procedures (p=0.027).
Awake video-assisted thoracoscopic surgery seems to be beneficial in reducing the incidence of postoperative pulmonary complications in high-risk patients as assessed with the ARISCAT.
本研究旨在使用加泰罗尼亚外科患者呼吸风险评估（ARISCAT）来评估清醒电视辅助胸腔镜手术对不同风险评分患者术后肺部并发症的影响。
回顾性分析2011年1月至2021年8月期间共246例行清醒电视辅助胸腔镜手术的患者（158例男性，88例女性；平均年龄：59.1±13.6岁；范围25至84岁）。根据ARISCAT评分，低分和中等分患者纳入L组（n = 173），高分患者（n = 73）纳入H组。镇静方案包括必要时咪达唑仑和芬太尼联合丙泊酚输注。通过面罩或鼻导管（2至5 L/分钟）输送氧气，维持氧饱和度>95%，并通过肋间神经阻滞实现镇痛。评估患者的人口统计学、手术和术后数据以及肺部并发症。
两组间人口统计学、手术和术后数据相似。H组20例（27%）患者和L组29例（17%）患者出现术后肺部并发症，差异无统计学意义（p = 0.056）。手术方式包括胸膜手术（n = 194）和肺切除术（n = 52）。与非肺部手术相比，肺切除术后肺部并发症的发生率显著更高（p = 0.027）。
根据ARISCAT评估，清醒电视辅助胸腔镜手术似乎有利于降低高危患者术后肺部并发症的发生率。
