Guan He, Bi Jinchao, Zheng Wantong, Zhang Yahao, Han Zhijun, Wei Li, Li Jiwei
Department of Thoracic Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Clinical Medical School of Zhengzhou University, Zhengzhou, Henan, China.
Department of Thoracic Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
Front Oncol. 2025 Jul 7;15:1602812. doi: 10.3389/fonc.2025.1602812. eCollection 2025.
Segmentectomy under non-intubated anesthesia (NIA) has demonstrated comparable conventional clinical outcomes to segmentectomy performed under intubated general anesthesia (IGA). However, differences in early patient-reported outcomes (PROs) between the two anesthetic approaches remain unclear. This study aimed to evaluate symptom burden and functional status from the patient's perspective under different anesthesia modalities.
Patients who underwent segmentectomy via either IGA or NIA were included. Perioperative symptom severity and functional status were assessed using the PSA-lung scale. PROs data were collected at various perioperative time points, and comparisons between groups were analyzed using a linear mixed-effects model.
Among the 380 enrolled patients, 160 underwent segmentectomy under NIA, and 220 under IGA. After propensity score matching (PSM), baseline characteristics were comparable between groups. On postoperative day 7, patients in the NIA group reported significantly milder symptoms of pain (P<0.001), cough (P<0.001), dyspnea (P=0.011), and drowsiness (P<0.001) compared to those in the IGA group. Additionally, the NIA group experienced less functional interference in walking (P<0.001) and general function (P<0.001). Within one month postoperatively, patients in the IGA group reported more severe cough (P<0.001) and anxiety (P<0.001) than those in the NIA group. There were no significant differences in short-term clinical outcomes between the two groups, although the NIA group had a longer operative time (P<0.001) but a shorter postoperative hospital stay (P<0.001).
PROs are essential indicators of postoperative recovery after segmentectomy. Compared to intubated anesthesia, non-intubated anesthesia is associated with fewer severe early symptoms, lower functional burden, and shorter hospitalization following segmentectomy.
非插管麻醉（NIA）下的肺段切除术已显示出与插管全身麻醉（IGA）下的肺段切除术相当的传统临床结果。然而，两种麻醉方法在早期患者报告结局（PROs）方面的差异仍不明确。本研究旨在从患者角度评估不同麻醉方式下的症状负担和功能状态。
纳入通过IGA或NIA进行肺段切除术的患者。使用PSA-肺量表评估围手术期症状严重程度和功能状态。在围手术期的不同时间点收集PROs数据，并使用线性混合效应模型分析组间比较。
在380名纳入的患者中，160名在NIA下进行肺段切除术，220名在IGA下进行。倾向得分匹配（PSM）后，两组的基线特征具有可比性。术后第7天，与IGA组相比，NIA组患者报告的疼痛（P<0.001）、咳嗽（P<0.001）、呼吸困难（P=0.011）和嗜睡（P<0.001）症状明显较轻。此外，NIA组在行走（P<0.001）和总体功能（P<0.001）方面的功能干扰较少。术后1个月内，IGA组患者报告的咳嗽（P<0.001）和焦虑（P<0.001）比NIA组更严重。两组的短期临床结果无显著差异，尽管NIA组的手术时间较长（P<0.001），但术后住院时间较短（P<0.001）。
PROs是肺段切除术后恢复的重要指标。与插管麻醉相比，非插管麻醉与较少的严重早期症状、较低的功能负担以及肺段切除术后较短的住院时间相关。
