| Objective:Spontaneous breathing non-tracheal intubation anesthesia as a novel anesthesia technique has been carried out in simple thoracic surgery.It can avoid airway trauma and complications caused by intubation,and provides different anesthesia for chest surgery In a retrospective study,we compared the perioperative conditions and postoperative rehabilitation indicators of patients in the non-intubated television thoracoscopic surgery(NIVATS)group with those of the concurrent intubated television thoracoscopic surgery(IVATS)group.Safety feasibility and potential clinical advantages of thoracoscopic early lung cancer treatment,providing a clinical basis for non-intubated thoracoscopic surgery widely used in early lung cancer treatmentMethods:This study is a retrospective study.By analyzing the Department of Thoracic Surgery in our hospital from October 2017 to December 2019,120 eligible patients with lung tumors treated by video-assisted thoracoscopy were performed,including44 males and 76 females example Lung tumors with a maximum diameter of no more than 3cm, without infiltration of the chest wall,diaphragm,pericardium,main bronchus,etc All patients are performed by the same team of surgeons and anesthesiologists According to the use of anesthesia,they were divided into 42 cases in the NIVATS group(ie,the case group)and 78 cases in the IVATS group(ie,the control group).Match the clinical basic data of the patient's gender,age,body mass index(BMI),smoking and drinking history,and combined basic diseases Analyze and compare the blood routine(white blood cell count,absolute neutrophil count)of the two groups of patients before and after 24 h and48h.Preoperative anesthesia preparation time,type of surgery,pathological classification of lung tumors,number of lymph node dissection groups and presence or absence of cancer metastasis,maximum diameter of lung tumors,clinical staging of lung tumors,operation time,and surgical bleeding Video-assisted thoracoscopic lung collapse,operative field exposure With or without cough reflexes,satisfaction with anesthesia,changes in vital signs during the operation,continuous blood gas analysis and monitoring,Urine volume,Bispectral Index(BIS)monitors anesthesia depth,length of hospital stay,postoperative fasting time,duration of thoracic drainage tube,Early time to get out of bed,total pleural effusion drainage,antibiotic use time,surgery Post-anaesthesia wake-up time or stay in an anesthesia resuscitation room(Postanesthesia Care Unit(PACU)),anesthesia cost,postoperative pain score for 24 hours,total hospitalization cost,postoperative airway-related complications,and other system-related complications.Results: All patients successfully completed video-assisted thoracoscopic surgery,and there were no cases of conversion to thoracotomy,perioperative death or respiratory failure.There was no case of emergency transfer to tracheal intubation general anesthesia in NIVATS group.The gender and age of patients in the NIVATS group were not significantly different from those in the IVATS group(p> 0.05)Classification of surgical methods for patients in the NIVATS group and IVATS group(p = 0.961),the number of lymph node dissection groups(p = 0.458),the maximum diameter of lung tumors(p = 0.719),the pathological classification of lung tumors(p = 0.817),lungs There was no significant statistical difference in clinical staging of all tumors(p =0.862).There was no significant difference in the average operating time(min)(70.83 and 78.67,p = 0.122)and the average blood loss(ml)(48.33 and 64.66,p = 0.060)between the NIVATS group and the IVATS group.Preoperative and postoperative 24 h and 48 h white blood cell counts and absolute neutrophil counts were not significantly different between the two groups of patients(p> 0.05),.In the NIVATS group,the indwelling time(h)of thoracic drainage tube after operation(80.38 ± 26.66 vs.99.88± 34.34,p = 0.002),the total drainage volume of thoracic drainage tube(ml)(546.90± 300.85 vs.826.65 ± 481.99,p <0.001)Time of postoperative antibiotic use(d)(3.96 ± 1.16 and 4.89 ± 1.62,p = 0.001),24-hour postoperative pain score(2.33 ±0.570 and 2.55 ± 0.501,p = 0.032),and time for preoperative anesthesia preparation(min)(30.48 ± 8.46 and 38.28 ± 13.27,p <0.001),wake-up time of anesthesia or stay in PACU(min)(39.93 ± 8.08 and 47.52 ± 17.69,p = 0.002),anesthesia cost(yuan)3891.71 ± 399.05,p <0.001),total cost of hospitalization(yuan)(52519.07 ±9790.93 and 59332.91 ± 10549.91,p = 0.001),length of stay(d)(9.60 ± 2.11 and10.91 ± 2.08,p = 0.001)and IVATS group compared to Non-intubated Video thoracoscopic surgery has clear advantages There were no significant differences in other complications(14.3% and 16.7%,p = 0.845)between the two groups of patients,but non-intubated thoracoscopic surgery can greatly improve the postoperative sore throat and dry coughConclusion:1.Through this study,we found that non-intubated anesthesia technology is safe and feasible for the treatment of early-stage non-small cell lung cancer by video-assisted thoracoscopy,and has obvious advantages in the short term.2.The results of the study show that non-intubated video-assisted thoracoscopic surgery can significantly improve patients 'fasting time and drainage after surgery,early removal of the drainage tube,short hospital stay,reduced antibiotic use,lowering the cost of anesthesia and total hospitalization costs,and reducing patients' financial burden and suffering To improve patients' quality of life3.It can also reduce the preparation time for anesthesiologists,rapid anesthesia and resuscitation of patients after surgery,short PACU stay time,reduced perioperative pain and throat discomfort,and higher patient acceptance,which is worthy of promotion in thoracic surgery. |
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