Secco Gianmarco, Vailati Davide, Basta Benedetta, Bonvecchio Emilio, Fusco Tiziana, Mori Luigi, Magistro Carmelo, Marino Giovanni
Departments of Anaesthesia and ICU, Melegnano Hospital, ASST Melegnano e Martesana, Vizzolo Predabissi, Milan, Italy.
Department of General Surgery, Melegnano Hospital, ASST Melegnano e Martesana, Vizzolo Predabissi, Milan, Italy.
Saudi J Anaesth. 2025 Oct-Dec;19(4):573-579. doi: 10.4103/sja.sja_372_25. Epub 2025 Sep 3.
Neuraxial anesthesia (NA), specifically thoracic spinal anesthesia (TSA), offers several theoretical advantages when compared to the General Anesthesia (GA). This retrospective study compares TSA with the gold standard GA in elective colorectal laparoscopic surgery and evaluates the impact on respiratory functions.
The data used in this study were extracted from the medical records of 34 consecutive patients, who had undergone laparoscopic colon resection surgery in Melegnano Hospital-ASST Melegnano Martesana-Italy and had been administered NA or GA. Postoperative lung function was assessed via lung ultrasound [Lung Ultrasound Score(LUS)], and PaO/FiO (P/F) ratio.
The average duration of the surgical procedure was 201.9 ± 50.4 min (NA 191.1 ± 44.1 vs. GA 212 ± 55.3 min, = 0.21). Arterial blood gas parameters showed a reduction in the postoperative values of P/F ratio (P/F: NA 387 ± 70 vs GA 342 ± 52, = 0.049). LUS reveals a higher prevalence of atelectasis in the poster-inferior lung regions. After surgery, the pre- and post-operative LUS scores (Delta LUS) showed differences in the GA group (NA 1.8 ± 1.8 vs GA 3.8 ± 1.9, = 0.003). The receiver operating characteristic (ROC) curve proved to be very accurate (area under the curve (AUC) = 0.898, < 0.001) in predicting postoperative oxygen support, even more so in the GA group (2 in the NA group vs 7 in the GA).
In the context of a progressively aging population and an increase in the fragility of patients, NA with spontaneous ventilation appears to exert a minor impact on respiratory function compared to GA.
与全身麻醉（GA）相比，神经轴索麻醉（NA），尤其是胸段脊髓麻醉（TSA）具有若干理论优势。本回顾性研究比较了择期结直肠腹腔镜手术中TSA与金标准GA，并评估其对呼吸功能的影响。
本研究使用的数据取自意大利梅莱尼亚诺医院 - 梅莱尼亚诺 - 马尔泰萨纳地方卫生管理局连续34例接受腹腔镜结肠切除术并接受NA或GA的患者的病历。通过肺部超声[肺部超声评分（LUS）]和动脉血氧分压/吸入氧分数（P/F）比值评估术后肺功能。
手术平均时长为201.9±50.4分钟（NA组191.1±44.1分钟，GA组212±55.3分钟，P = 0.21）。动脉血气参数显示术后P/F比值降低（P/F：NA组387±70，GA组342±52，P = 0.049）。LUS显示下肺后段肺不张的发生率更高。术后，GA组术前和术后LUS评分（LUS差值）存在差异（NA组1.8±1.8，GA组3.8±1.9，P = 0.003）。受试者工作特征（ROC）曲线在预测术后氧支持方面非常准确（曲线下面积（AUC）= 0.898，P < 0.001），在GA组中更是如此（NA组2例，GA组7例）。
在人口逐渐老龄化以及患者脆弱性增加的背景下，与GA相比，自主通气的NA对呼吸功能的影响似乎较小。
