曾垂应 赖玥

【摘要】 目的 觀察单孔胸腔镜下保留自主呼吸喉罩麻醉在肺大泡切除术中的应用效果。

方法 选择2018年5月至2020年5月在福建省龙岩市第二医院行单孔胸腔镜肺大泡切除术治疗的患者98例，根据随机数字表分为对照组（n=49）和研究组（n=49）。对照组采用双腔支气管导管插管全麻，研究组采用保留自主呼吸喉罩麻醉。比较两组术后恢复指标、治疗费用，插管前后HR、MAP变化情况及术后并发症发生率。

结果 与对照组相比，研究组术后苏醒时间、住院时间、下床活动时间短，住院总费用少，差异有统计学意义（P<0.001）;两组插管后HR、MAP均较插管前降低，研究组HR、MAP高于对照组，差异有统计学意义（P<0.01）;研究组并发症发生率低于对照组，差异有统计学意义（P<0.05）。

结论 单孔胸腔镜肺大泡切除术采用保留自主呼吸喉罩麻醉可降低并发症发生率，缩短患者术后恢复时间，减少治疗费用。

【关键词】 单孔胸腔镜;肺大泡切除术;保留自主呼吸喉罩麻醉;双腔支气管导管

中图分类号：R614.2   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.09.013

Application of anesthesia with laryngeal mask airway with spontaneous breathing under single-hole thoracoscopy in bullae resection

ZENG Chuiying， LAI Yue

（Department of Anesthesiology， The Second Hospital of Longyan City， Longyan 364100， Fujian， China）

【Abstract】 Objective To observe the effect of anesthesia with laryngeal mask airway with spontaneous breathing under single-hole thoracoscopy in bullae resection.

Methods From May 2018 to May 2020， 98 patients with single-hole thoracoscopic bulla resection in our hospital were selected and divided into control group （n = 49） and study group （n = 49） by random number table. The control group were anesthetized with double-lumen endobronchial tube， and the study group were anesthetized with laryngeal mask airway with spontaneous breathing. And then， postoperative recovery indexes， treatment costs， changes in HR and MAP before and after intubation， and the incidence of postoperative complications were compared between the two groups.

Results Compared with the control group， the study group had shorter postoperative awakening time， hospitalization time and time of out-of-bed activity， and less total hospitalization cost， and the difference was statistically significant （P < 0.001）. After intubation， HR and MAP in both groups were lower than those before intubation， while those in the study group were higher than those in the control group， and the difference was statistically significant （P < 0.01）. The incidence of complications in the study group was lower than that in the control group， and the difference was statistically significant （P < 0.05）.

Conclusion Anesthesia with laryngeal mask airway with spontaneous breathing in bullae resection can reduce the incidence of complications， shorten postoperative recovery time and reduce treatment cost.

【Key words】 single-hole thoracoscopy; bullae resection; anesthesia with laryngeal mask airway with spontaneous breathing; double-lumen endobronchial tube

单孔胸腔镜肺大泡切除术是临床治疗自发性气胸的一种有效方式，而有效的麻醉方式是手术成功与否的关键所在[1～2]。全身麻醉下插入双腔支气管导管实施肺隔离是以往临床常用麻醉方式，虽具有良好的麻醉效果，但易引起气道损伤、喉水肿等并发症，且部分患者应用肌松药后，可出现神经肌肉阻滞，严重影响患者肺功能[3～4]。近年来，随着临床麻醉学的不断发展，保留自主呼吸喉罩麻醉逐渐应用于临床，具有刺激性低、舒适度高、创伤小等优点，在保证麻醉效果的同时，可降低机体应激反应，维持血流动力学稳定，提高手術安全性[5～7]。……