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全国非气管内插管胸外科手术与麻醉研讨会12月4日在广州附一院顺利闭幕，丁香园记者在会议现场或会后对部分参会者进行了采访，也截取了网上讨论中部分参会医生的发言，供大家参阅。
清醒状态下胸腔镜手术切除肺孤立性结节的结果及可行性分析
Feasibility and Results of Awake Thoracoscopic
Resection of Solitary Pulmonary Nodules
Background: General anesthesia with single-lung ventilation is considered mandatory for thoracoscopic pulmonary resection. We assessed in a randomized study the feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules.
Methods: Between March 2001 and February 2003, 60 patients were randomized into two 30-patients arms: a general anesthesia arm entailing double-lumen intubation and thoracic epidural anesthesia (control group); and an awake arm entailing sole thoracic epidural anesthesia at T4-T5 (awake group). Anesthesia time; operative time; global operating room time; patient satisfaction with the anesthesia and technical feasibility scored into 4 grades (from 1＝poor to 4 ＝excellent); visual analog pain score(VAS), nursing care (number of patient calls per day), 24hours changes in arterial oxygenation (PaO2), and hospital stay were assessed.
Results: There was no mortality. There was no difference in technical feasibility between the groups although 2 patients in the awake group required conversion to thoracotomy due to severe adhesions. Other 2 patients in each group required conversion due to unexpected lung cancer requiring lobectomy. Comparisons of awake versus control group results showed that in the awake group, anesthesia satisfaction score was greater (4 vs 3, p＝0.04), whereas PaO2 (-3 mm Hg vs -6.5 mm Hg, p＝0.002); nursing care (2.5 calls per day vs 4 calls per day, p＝0.0001), and hospital stay (2 days vs 3 days, p＝0.02) were significantly reduced.
Conclusions: In our study, awake thoracoscopic resection of solitary pulmonary nodules proved safely feasible. It resulted in better patient satisfaction, less nursing care and shorter in-hospital stay than procedures performed under general anesthesia.
编辑: sy850701 作者:丁香园通讯员
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