非气管插管麻醉在肺大疱切除术中的应用

Application of Non-Tracheal Intubation Anesthesia in Pulmonary Bullae Resection

摘要: 目的：探讨多模式镇痛后保留自主呼吸非气管插管(Tubeless)麻醉技术在胸腔镜肺大疱切除术中的可行性、安全性、有效性及临床应用价值。方法：选取行胸腔镜肺大疱切除术的患者90例，按麻醉方式不同分为对照组(双腔支气管插管全身麻醉)和观察组(多模式镇痛后保留自主呼吸非气管插管麻醉)，每组45例。观察组采用静脉全麻复合肋间神经阻滞及迷走神经阻滞，置入喉罩并保留自主呼吸。对比两组患者术中血流动力学指标、术后恢复指标及并发症发生率。结果：Tubeless麻醉技术可有效避免气管插管相关并发症，维持术中血流动力学稳定，术后患者苏醒快、住院时间短、医疗费用降低。结论：保留自主呼吸非气管插管全身麻醉用于胸腔镜肺大疱切除术对比传统双腔气管插管，血流动力学更稳定，术后恢复快，并发症少，安全可行，符合快速康复外科(ERAS)理念。

Abstract: Objective: To investigate the feasibility, safety, efficacy, and clinical value of tubeless anesthesia with preserved spontaneous breathing following multimodal analgesia in video-assisted thoracoscopic surgery (VATS) bullectomy. Methods: Ninety patients undergoing VATS bullectomy were enrolled and divided into two groups based on anesthesia technique: the control group (double-lumen endobron- chial intubation general anesthesia) and the observation group (tubeless anesthesia with preserved spontaneous breathing following multimodal analgesia), with 45 cases in each group. The observation group received intravenous general anesthesia combined with intercostal nerve block and vagus nerve block, with laryngeal mask airway placement and spontaneous breathing preservation. Intraoperative hemodynamic parameters, postoperative recovery indices, and complication rates were compared between the two groups. Results: Tubeless anesthesia effectively avoided intubation-related complications, maintained stable intraoperative hemodynamics, and resulted in faster postoperative awakening, shorter hospital stay, and reduced medical costs. Conclusion: Compared with conventional double-lumen endotracheal intubation, general anesthesia with preserved spontaneous breathing without tracheal intubation for VATS bullectomy demonstrates more stable hemodynamics, faster postoperative recovery, fewer complications, and is safe and feasible, consistent with the enhanced recovery after surgery (ERAS) concept.