Study on non-intubated anesthesia with preserved spontaneous respiration in thoracoscopic surgery
保留自主呼吸的非气管插管麻醉在胸腔镜手术中的研究

摘要

目的 探讨保留自主呼吸的非气管插管麻醉（non-intubated anesthesia with spontaneous breathing, NIVATS）在胸腔镜手术中的安全性、有效性及对患者术后康复的影响。方法 选取2024年1月至2025年12月在我院行胸腔镜手术的患者200例，随机分为观察组（NIVATS组，n=100）和对照组（传统双腔气管插管麻醉组，n=100）。观察组采用超声引导下胸椎旁神经阻滞复合喉罩通气保留自主呼吸，对照组采用双腔气管插管全身麻醉。比较两组患者的围术期指标、术后并发症发生率、术后恢复情况及膈肌功能变化。结果 观察组患者术后苏醒时间（12.5±3.2 min vs 28.7±5.6 min）、拔管时间（15.3±4.1 min vs 35.8±6.9 min）显著短于对照组（P<0.001）；术后肺部并发症发生率（17.0% vs 34.0%）、膈肌功能障碍发生率（34.0% vs 58.0%）显著低于对照组（P<0.05）；观察组术后24 h疼痛评分（VAS：3.1±1.2 vs 5.8±1.5）显著低于对照组（P<0.001），术后住院时间（4.2±1.1 d vs 6.5±1.8 d）显著缩短（P<0.001）。两组患者手术时间、术中出血量差异无统计学意义（P>0.05）。结论 保留自主呼吸的非气管插管麻醉在胸腔镜手术中安全有效，可减少术后并发症，促进患者快速康复，尤其在保护膈肌功能方面具有显著优势，值得临床推广应用。

Abstract

Objective To investigate the safety, effectiveness, and impact on postoperative recovery of non intubated anesthesia with spontaneous breathing (NIVATS) in thoracoscopic surgery.
Methods 200 patients who underwent thoracoscopic surgery in our hospital from January 2024 to December 2025 were randomly divided into an observation group (NIVATS group, n=100) and a control group (traditional double lumen endotracheal intubation anesthesia group, n=100). The observation group received ultrasound-guided thoracic paravertebral nerve block combined with laryngeal mask airway ventilation to preserve spontaneous breathing, while the control group received general anesthesia with double lumen endotracheal intubation. Compare the perioperative indicators, incidence of postoperative complications, postoperative recovery, and changes in diaphragm function between two groups of patients.
Results The postoperative recovery time (12.5 ± 3.2 min vs 28.7 ± 5.6 min) and extubation time (15.3 ± 4.1 min vs 35.8 ± 6.9 min) of the observation group were significantly shorter than those of the control group (P<0.001); The incidence of postoperative pulmonary complications (17.0% vs 34.0%) and diaphragmatic dysfunction (34.0% vs 58.0%) were significantly lower than those in the control group (P<0.05); The postoperative 24-hour pain score (VAS: 3.1 ± 1.2 vs 5.8 ± 1.5) in the observation group was significantly lower than that in the control group (P<0.001), and the postoperative hospitalization time (4.2 ± 1.1 days vs 6.5 ± 1.8 days) was significantly shortened (P<0.001). There was no statistically significant difference in surgical time and intraoperative bleeding between the two groups of patients (P>0.05).
Conclusion   Non tracheal intubation anesthesia with preserved spontaneous breathing is safe and effective in thoracoscopic surgery, can reduce postoperative complications, promote rapid recovery of patients, and has significant advantages in protecting diaphragm function, which is worthy of clinical promotion and application.