Comparison Of Different Airway Management In Thoracoscopic Pulmonary Bullae Resection:A Systematic Review

Objective: To explore the clinical application effect of thoracoscopic resection of pulmonary bullae in different airway management ways.Methods: To retrospectively analyse 87 cases of patients who had thoracoscopic resection of pulmonary bullae in the the second affiliated Hospital of Dalian Medical University from January 2016 to February 2017.According to the study,inclusion criteria is ASA Grade Ⅰ-Ⅱ,BMI<25kg/m2,primary spontaneous pneumothorax,single-port thoracoscopic surgery,and exclusion criteria is Age > 60 years old,ASA grade ≥ Ⅲ,BMI ≥ 25kg/m2,relay thoracotomy,disease of respiratory system,circulatory system disease and blood system,patients who are unable to cooperate with mental disorder.Finally,a total of 60 patients were included in this retrospective study,including 30 cases of patients in the tracheal intubation group（Group A）and 30 cases of patients in the non-intubated group（Group B）.Among them,52 cases are male（82.7%）and 8 are female（13.3%）,between 15-45 years old,with a weight of 42-75 kg,within ASA Ⅰ-Ⅱand Mallampatis Ⅰ.All patients were required to abstain from food and drink for 6 hours before the surgery and forbidden drink,have a routine intravenous drip by the upper limb after entering the operating room and be connected to the monitor.The normal side of patients were chosen to receive radial artery puncture,and their SBP,DBP,HR,SPO₂,ECG,BIS,PH,PaO₂,PaCO₂ and K+ were monitored.They had intravenous infusion of 0.5mg of penehyclidine hydrochloride injection before surgery.All patients before anesthesia induction had thoracic paravertebral nerve block,took a lateral position with operative side upward,back arched and head bowed,corresponding rib clearance（T4^T5 or T5^T6）to the surgical side incision 2.5 cm from the median line of the spine and the skin disinfected routinely.Then the patients received para vertebral block guided by ultrasound and injected 30 ml of 0.33% ropivacaine after drawing no blood back.The tracheal intubation group were inserted with double lumen endotracheal intubation after the routine anesthesia induction,catheter location were adjusted through fiber bronchoscope and the group were given pure oxygen mechanical ventilation after the insertion succeeded;the non-intubated group had the surgery by retaining spontaneous respirations and inhaling oxygen through anaesthesia masks without the skeletal muscular relaxants.Compare the physiological indexes of two groups of patients: Systolic Blood Pressure（SBP）,Diastolic Blood Pressure（DBP）,Heart Rate（HR）,saturation of pulse oximetry（SPO₂）,PH,Partial Pressure of Arterial Oxygen（PaO₂）,Partial Pressure of Arterial Carbon Dioxide（PaCO₂）,potassium ion（K+）;intraoperative evaluation indexes: duration of operation,surgical field exposure,anesthetic effect,awakening time;postoperative recovery evaluation index: postoperative feeding time,postoperative ambulation time,and the extraction time of thoracic drainage tubes,hospitalization time;postoperative complications evaluation index: Postoperative pharyngalgia incidence,incidence of postoperative nausea and vomiting,pulmonary complications,circulatory system complications.Other indexes include the costs of narcotic drugs,surgery costs and hospitalization costs.Results: the operations were completed smoothly in both kinds of ventilation ways,vital signs of all patients were stable and surgical field and anesthetic effects were satisfactory.There was no statistical significance in the differences of age,height and weight in both groups（P>0.05）.SBP and DBP of Group A and Group B at T1,T2,T3,T4 and T5 decreased compared with those at T0 and there was statistical significance in the differences（P<0.05）;SBP and DBP of Group A were higher than those of Group B only at T5 and there was statistical significance in the differences（P<0.05）.SPO₂ of Group A vs SPO₂ of Group B at T1、T5 have difference was statistically significant（P<0.05）.BIS of Group A vs BIS of Group B at T1 was [（43.5 ± 4.4）vs（50.5 ± 8.3）] and the difference was statistically significant（P<0.05）.PaCO₂ of Group B was obviously higher than that of Group A at T2,T3,T4 and T5 [（37.7 ± 2.3）mmHg vs（59.1 ± 9.9）mmHg,（37.2 ± 2.5）mmHg vs（66.7 ± 8.4）mmHg,（39.0 ± 2.3）mmHg vs（62.1 ± 6.6）mmHg,（40.7 ± 4.0）mmHg vs（56.6 ±）6.7 mmHg],and the difference was statistically significant（P<0.05）.Intraoperative evaluation indexes: There were no significant differences in surgical field exposure and anesthetic;Group B vs Group A in duration of operation and awakening time of were obviously shortened [（43.6 ± 8.4）min vs（63.6 ± 22.2）min],[（9.3 ± 4.2）min vs（19.8 ± 15.2）min] and the differences were statistically significant（P<0.05）.Postoperative recovery evaluation index: Group B vs Group A in postoperative feeding time [（0.51 ± 0.1）days vs（0.26 ± 0.04）days] and ambulation time [（1.00 ± 0.18）days vs（0.67 ± 0.11）days] distinctly shortened,and the differences were statistically significant（P < 0.05）;there was no statistical difference（P>0.05）in the comparison of the extraction time of thoracic drainage tubes and the hospitalization time.Postoperative complications evaluation index:postoperative pharyngalgia incidence of Group B vs Group A was [（0/30）vs（18/30）] and the difference was statistically significant（P<0.05）;the incidence of postoperative nausea and vomiting in Group B vs Group A was [（0/30）vs（2/30）].Only one case in group A had pulmonary complications,and no circulatory complications occurred in all patients.Other indexes:there were differences in the costs of narcotic drugs [（1724.23 ± 296.52）yuan vs（1128.53 ± 395.28）yuan,P<0.05] and hospitalization costs [（35678.95 ± 9632.88）yuan vs（31483.78 ± 5666.00）yuan] and the difference was statistically significant（P<0.05）.Surgery costs of Group A vs Group B was [（5565.23 ±）806.27 yuan vs（5181.70 ± 680.52）yuan,p>0.05] and there was no significant difference.Conclusion: During the thoracoscopic resection of pulmonary bullae in different airway management ways,the operations were completed smoothly.The duration of thoracoscopic resection of pulmonary bullae in a non-tracheal intubation way,awakening time and recovery time are shorter,and the costs of narcotic drugs and hospitalization expenses is less.The surgery is worthy of further promotion.