| BackgroundTracheal intubation ventilation is the most commonly used ventilation mode for Video assisted thoracic surgery(VATS),which can prevent the contamination of the healthy side of the lung and prevent the mistaken aspiration of the gastric contents.However,tracheal intubation can cause injury to the trachea,causing some difficult complications during and after the operation,such as mechanical ventilated lung injury,ischemia reperfusion injury,postoperative hoarseness,cough,and expectoration difficulties.At present,fast track surgery is the development trend of surgery,and these injuries are not consistent with the concept of fast track surgery.With the development and maturity of the technology of lung isolation and anesthesia management in the Department of thoracic surgery,some scholars have applied non tracheal intubation ventilation in VATS,hoping to reduce the injury caused by tracheal intubation and narcotic drugs.At present,several large units at home and abroad have applied non tracheal intubation ventilation technology to VATS,and have successively succeeded in rapid postoperative rehabilitation.Objective1.The feasibility of the application of non tracheal intubation ventilation in Department of thoracic surgery VATS was discussed.2.To evaluate the application value of non tracheal intubation ventilation in the rapid rehabilitation of VATS in Department of thoracic surgery.MethodsThe patients were selected strictly according to the entry group and the exclusion criteria.From July 2015 to August 2017,the ventilation technique in the experimental group was combined with laryngeal mask and intravenous sedation and analgesia,and the chest diseases(7 cases of mediastinal tumors,1 cases of chest wall tumor,14 cases of wedge resection of lung,8 cases of lobectomy)were selected for VATS resection,while the ventilation technique in the control group was gas tube intubation plus static inhalation anesthesia.Similarly,9 cases of mediastinal tumor,15 cases of pulmonary wedge resection and 12 cases of lobectomy were selected for VATS resection.For lung cancer patients,the two groups were routinely lobectomy and mediastinal,hilar and pulmonary lymph node dissection.In the experimental group,the blood gas analysis in the experimental group was selected at the three time of 10min,15min and 30min after the induction of anesthesia in the experimental group,and the influence of the experimental group on the changes of blood gas analysis was compared in the experimental group at the three times.The effect of operation and the index of anesthesia effect were selected in the two groups,such as the effect of anesthesia,the satisfaction of the leakage of the operation field,the time of operation,the time of anesthesia,the waking time after the operation,the amount of bleeding during the operation,and the difference of the above indexes in the two groups.The postoperative rapid rehabilitation index selected the time of extraction of thoracic drainage tube,the incidence of cough,pharynx discomfort,the incidence of hoarseness,the time of postoperative hospitalization,and the difference of the blood routine(leukocyte and lymphocyte)between the two groups before and after the operation,and compared the differences of the above two groups.Results1.None of the patients in the experimental group needed transesophageal endotracheal intubation.Although the arterial blood gas analysis index will decrease after 15min,the 30min level can be restored to 1min level before anesthesia induction.There was no significant difference between the two groups in terms of operative time,anesthetic time,field exposure satisfaction and bleeding volume(P>0.05).But the wakefulness time of the experimental group was significantly lower than that of the control group,and there was statistical difference(P<0.05).2.The difference of leukocyte and lymphocyte,extraction of thoracic drainage tube time,cough,pharynx discomfort,hoarseness and time of hospitalization in the experimental group were significantly smaller than those in the control group,and the difference was statistically significant(P<0.05).Conclusion1.Through strict screening of patients,non tracheal intubation ventilation is highly feasible and safe in the VATS of Department of thoracic surgery,especially in simple surgery such as wedge resection of the lung.2.The way of non tracheal intubation technique is less irritation to patients’ respiratory and throat and reduce airway damage.Non tracheal intubation ventilation technology is applied in Department of thoracic surgery VATS,which is conducive to rapid rehabilitation. |
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