自主呼吸非气管插管硬膜外麻醉下单孔胸腔镜手术治疗非小细胞肺癌的疗效分析

doi:10.11958/20250130

摘要/Abstract

摘要：

目的探讨非插管胸腔镜手术硬膜外麻醉下单操作孔治疗非小细胞肺癌（NSCLC）的疗效及安全性。方法选取180例NSCLC患者，采用倾向得分临近匹配法进行匹配后分为A组、B组、C组和D组，各45例。A组实施非插管胸腔镜手术硬膜外麻醉下单操作孔手术，B组实施非插管胸腔镜手术硬膜外麻醉下三操作孔手术，C组实施双腔气管插管全身麻醉下单操作孔手术，D组实施双腔气管插管全身麻醉下三操作孔手术。比较4组麻醉相关指标，手术相关指标和手术前1 d、术后1个月CD3⁺、CD4⁺、CD4⁺/CD8⁺，第1秒用力呼气容积（FEV₁）、每分钟最大通气量（MVV）和用力肺活量（FVC）及并发症发生率。结果 A组和B组麻醉准备时间、首次肛门排气时间和首次下床活动时间短于C组和D组，丙泊酚和瑞芬太尼用量少于C组和D组（P<0.05）；与其他3组比较，A组术后引流、住院时间最短，术后1个月CD3⁺、CD4⁺、CD4⁺/CD8⁺和FEV₁、FVC、MVV最高（P<0.05）；术后1个月，4组CD3⁺、CD4⁺和CD4⁺/CD8⁺、FEV₁、FVC和MVV均低于术前1 d，A组术后并发症总发生率低于其他3组（P<0.05）。结论非插管胸腔镜手术硬膜外麻醉下单操作孔手术可提高NSCLC患者临床疗效，减少阿片类药物用量，安全性好。

关键词: 癌，非小细胞肺, 麻醉，硬膜外, 非气管插管, 单操作孔胸腔镜手术, 阿片类药物

Abstract:

Objective To investigate the efficacy and safety of non-intubated thoracoscopic surgery in the treatment of non-small cell lung cancer (NSCLC). Methods A total of 180 NSCLC patients were selected and matched by propensity score proximity matching method. Patients were divided into the group A, the group B, the group C and the group D, with 45 cases each. Patients in the group A underwent non-intubated thoracoscopic surgery epidural anesthesia with single operation hole operation, the group B underwent non-intubated thoracoscopic surgery epidural anesthesia with three operation holes, the group C underwent double-cavity tracheal intubation with general anesthesia with single operation hole operation and the group D underwent double-cavity tracheal intubation with three operation holes under general anesthesia. Anesthesia related indexes, surgical related indexes, CD3⁺, CD4⁺, CD4⁺/CD8⁺, 1-second forced expiratory volume (FEV₁), maximal voluntary ventilation (MVV), forced vital capacity (FVC) and complication rate of the 4 groups were compared 1 day before surgery and 1 month after surgery. Results The anesthetic preparation time, first anal exhaust time and first getting out of bed time were shorter in the group A and the group B than those in the group C and the group D, and the dosage of propofol and remifentanil was lower in the group A and the group B than that in the group C and the group D (P<0.05). Compared with the other 3 groups, the group A had the shortest postoperative drainage and hospital stay, and the highest CD3⁺, CD4⁺, CD4⁺/CD8⁺ and FEV₁, FVC and MVV at 1 month after surgery (P<0.05). One month after surgery, CD3⁺, CD4⁺, CD4⁺/CD8⁺, FEV₁, FVC and MVV were lower than 1 day before surgery in the 4 groups. The total incidence of postoperative complications was lower in the group A than that of the other 3 groups (P<0.05). Conclusion Non-intubated thoracoscopic surgery with epidural anesthesia and single operation hole can improve the clinical efficacy of NSCLC patients, reduce the dosage of opioids and have good safety.

Key words: carcinoma, non-small-cell lung, anesthesia, epidural, non-tracheal intubation, single-hole video-assisted thoracic surgery, opioid

中图分类号:

R734.2，R614

图/表 6

参考文献 19

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组别	男性	年龄/ 岁	体质量指数/（kg/m²）	ASA分级（Ⅰ级/Ⅱ级）	吸烟史
A组	26	57.67±4.36	23.19±1.10	29/16	15
B组	20	57.96±5.38	23.05±0.75	30/15	17
C组	29	59.36±3.82	22.97±0.86	21/24	10
D组	31	58.02±2.89	22.99±0.79	33/12	12
χ²或F	6.334	1.443	1.026	7.489	3.069

组别	男性	年龄/ 岁	体质量指数/（kg/m²）	ASA分级（Ⅰ级/Ⅱ级）	吸烟史
A组	26	57.67±4.36	23.19±1.10	29/16	15
B组	20	57.96±5.38	23.05±0.75	30/15	17
C组	29	59.36±3.82	22.97±0.86	21/24	10
D组	31	58.02±2.89	22.99±0.79	33/12	12
χ²或F	6.334	1.443	1.026	7.489	3.069

组别	麻醉准备时间/min	丙泊酚用量/mg	瑞芬太尼用量/μg	首次肛门排气时间/h	首次下床活动时间/h
A组	23.58±2.89	647.29±111.27	519.11±59.69	8.09±0.95	13.87±1.29
B组	24.16±2.21	651.04±146.55	519.09±54.30	8.07±0.69	14.02±0.97
C组	39.00±3.32^ab	792.60±151.30^ab	610.27±62.36^ab	9.91±1.35^ab	18.91±1.47^ab
D组	38.91±4.18^ab	786.20±134.18^ab	608.20±64.71^ab	9.84±1.40^ab	19.31±1.47^ab
F	20.120^＊＊	2.736^＊＊	1.576^＊	13.057^＊＊	51.488^＊＊

组别	麻醉准备时间/min	丙泊酚用量/mg	瑞芬太尼用量/μg	首次肛门排气时间/h	首次下床活动时间/h
A组	23.58±2.89	647.29±111.27	519.11±59.69	8.09±0.95	13.87±1.29
B组	24.16±2.21	651.04±146.55	519.09±54.30	8.07±0.69	14.02±0.97
C组	39.00±3.32^ab	792.60±151.30^ab	610.27±62.36^ab	9.91±1.35^ab	18.91±1.47^ab
D组	38.91±4.18^ab	786.20±134.18^ab	608.20±64.71^ab	9.84±1.40^ab	19.31±1.47^ab
F	20.120^＊＊	2.736^＊＊	1.576^＊	13.057^＊＊	51.488^＊＊

组别	手术时间/h	术中出血量/mL	淋巴结清扫数/个	术后1d VAS评分/分	术后引流时间/d	住院时间/d
A组	1.98±0.62	87.58±6.39	13.20±1.86	1.24±0.43	3.20±0.66	9.02±2.26
B组	2.04±0.74	89.18±5.92	13.33±1.75	1.27±0.54	3.91±0.63^a	10.73±3.22^a
C组	2.02±0.45	88.53±6.04	14.04±1.59	1.33±0.64	4.24±0.74^a	11.07±3.19^a
D组	2.13±0.79	90.42±7.17	13.91±1.52	1.31±0.47	4.07±0.65^a	10.98±2.51^a
F	0.660	1.169	1.494	0.297	10.126^＊＊	5.770^＊＊