| Objective:A comparative study of independent respiratory anesthesia and tracheal intubation under general anesthesia for thoracoscopic bullae resection,observation and comparison of intraoperative and postoperative indexes,and further guidance of the application of spontaneous respiratory anesthesia in clinical practice.Methods:A retrospective study of 60 patients with spontaneous pneumothorax undergoing surgical treatment from June 2015 to October2017 in the Department of Thoracic and Cardiovascular Surgery of the Second Affiliated Hospital of Nanhua Hospital.All cases entered the spontaneous respiratory anesthesia group and the tracheal intubation general anesthesia group before surgery.Both groups were treated with single hole thoracoscopic bulla resection.Inclusion criteria:ASA grade I-II grade,BMI<25Kg/m~2,preoperative assessment of feasible bullae resection,normalcardiopulmonaryfunctioncantolerate surgery;Exclusion criteria:age>55 years old,ASA grade?grade III,BMI?25 kg/m~2,conversion to open chest surgery,history of thoracic surgery on the ipsilateral side,complications of pulmonary infection,history of tuberculosis,etc.,or diffuse pulmonary emphysema Wait,Patients with cardiovascular diseases,connective tissue diseases,metabolic diseases,and mental disorders cannot be co-operated.Intraoperative exploration revealed extensive thoracic adhesions.A total of 60 patients were included in this retrospective study,including 30 patients with spontaneous respiratory anaesthesia(Group A)and 30 patients with general anesthesia(Group B).Therefore,patients fasted for8 hours before fasting,and routinely established peripheral vein channels,ECG monitoring,etc.after admission,observed heart rate(HR),blood pressure(BP),and collected arterial blood samples.Analyze blood gas analysis 15 minutes after the start of surgery.12 and 48 hours after the operation,the number of white blood cells,the ratio of neutrophils,lymphocyte ratio,the number of neutrophils,C-reactive protein,procalcitonin,to assess the total time of surgery,operation time,drainage,eating time,postoperative Hospital stay,hospitalization expenses,extubation time.Results:The operations of spontaneous respiratory anesthesia group and tracheal intubation general anesthesia group were successfully completed.The number of leukocytes in the spontaneous respiratory anesthesia group(8.93±2.09×10~9 vs.10.52±3.41×10~9,p=0.01),neutrophils at 12 hours after operation Ratio(%)(68.0±18.5 vs.74.7±11.7,p=0.04),lymphocyte ratio(%)(12.9±3.6 vs 16.9±7.2,p=0.004),neutrophil count(7.5±3.5×10~9 vs.9.0±2.6×10~9,p=0.03),C-reactive protein(mg/L)(32.2±19.7 vs 49.2±35.4,p=0.01),procalcitonin(ug/L)(0.09±0.12 vs.0.39±0.81,p=0.02);The number of white blood cells at48 hours after surgery(7.96±2.89×10~9 vs.10.02±4.12×10~9,p=0.01),neutrophil ratio(%)(70.37±9.69 vs.75.48±9.17,p=0.02),lymphocyte ratio(%(10.59±4.9 vs 14.6±11.8,p=0.04),neutrophil numbers(7.3±3.2×10~9 vs.9.6±3.6×10~9,p=0.005),C-reactive protein(mg/L)(26.4±9.3vs.34.9±10.9,p<0.05),procalcitonin(ug/L)(0.05±0.05 vs.0.11±0.18,p=0.05);Postoperative hospital stay(d)(2.6±1.1 vs 3.4±1.1,p=0.003),drainage volume(ml)(236±121.7 vs 222.8±147,p=0.35),operation time:including anesthesia,surgery,and resuscitation time(min)(55.6±18.2 vs.113.3±37.2,p<0.05),eating time(min)(258.5±81.4 vs.464.2±81.7,p<0.05),hospitalization cost(yuan)(31379.1±1514.8 vs.34657.4±1403.4,p<0.05),operation time(min)(34.3±10.3 vs 31.4±9.9,p=0.13),extubation time(h)(6.8±1.1 vs 6.6±1.3,p=0.278);Blood gas analysis 15 minutes after surgery:PCO2(mm Hg)(60.7±7.4 vs 46.7±7.8,p<0.05),PO2(mm Hg)(106.6±22.9 vs 113.3±37.2,p=0.2),blood lactate(mmol/L)(1.2±0.4 vs.1.0±0.4,p=0.06).Conclusions:1.Patients with indications who are assessed,under spontaneous breathing anesthesia thoracoscopic lavage resection,can reduce the inflammatory response;2.Patients with indications who are assessed,under spontaneous breathing anesthesia thoracoscopic alveolar laparoscopic resection is safe and feasible,the patient recovered quickly. |
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