Huang Hsiang-Han, Chen Li-Hua, Lai Hou-Chuan, Wu Zhi-Fu, Ko Ching-Lung, Lo Kai-Li, Huang Go-Shine, Tseng Wei-Cheng
Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
Graduate Institute of Public Health, National Defense Medical Center, Taipei 114, Taiwan.
J Clin Med. 2025 May 15;14(10):3466. doi: 10.3390/jcm14103466.
Previous studies have shown that ventilation strategies used in general anesthesia influence perioperative outcomes of video-assisted thoracoscopic surgery (VATS). This study investigated the perioperative effects of non-intubated anesthesia (NIA) versus intubated anesthesia (IA) in patients with early-stage non-small cell lung cancer (NSCLC) undergoing VATS. This retrospective cohort study analyzed patients who underwent elective VATS for early-stage NSCLC between January 2015 and December 2022. Patients were categorized into the NIA and IA groups based on the ventilation strategies during general anesthesia. Comprehensive outcome data, including intraoperative and postoperative variables, were compared between the two groups. Univariate and multivariate logistic regression models were used to assess the odds ratios for conversion from NIA to IA. A total of 372 patients who received NIA and 1560 who received IA for VATS were eligible for analysis. After propensity score matching, 336 patients were included in each group. In the matched analysis, patients who received NIA demonstrated favorable perioperative outcomes, including reduced opioid consumption, lower postoperative complication rates, and shorter hospital stays, compared to those who received IA. Additionally, patients with a lower baseline oxygen saturation and those who experienced intraoperative pulmonary and cardiovascular adverse events had a higher risk of conversion from NIA to IA. NIA during VATS in patients with early-stage NSCLC was associated with superior perioperative outcomes. Prospective studies are warranted to further evaluate the impact of NIA on perioperative outcomes in this patient population.
既往研究表明，全身麻醉中使用的通气策略会影响电视辅助胸腔镜手术（VATS）的围手术期结局。本研究调查了非插管麻醉（NIA）与插管麻醉（IA）对接受VATS的早期非小细胞肺癌（NSCLC）患者围手术期的影响。这项回顾性队列研究分析了2015年1月至2022年12月期间接受择期VATS治疗早期NSCLC的患者。根据全身麻醉期间的通气策略将患者分为NIA组和IA组。比较两组的综合结局数据，包括术中和术后变量。采用单因素和多因素逻辑回归模型评估从NIA转换为IA的比值比。共有372例接受VATS的NIA患者和1560例接受IA的患者符合分析条件。倾向得分匹配后，每组纳入336例患者。在匹配分析中，与接受IA的患者相比，接受NIA的患者围手术期结局良好，包括阿片类药物消耗量减少、术后并发症发生率较低和住院时间较短。此外，基线血氧饱和度较低以及术中发生肺部和心血管不良事件的患者从NIA转换为IA的风险较高。早期NSCLC患者VATS期间的NIA与更好的围手术期结局相关。有必要进行前瞻性研究，以进一步评估NIA对该患者群体围手术期结局的影响。
