非插管全身麻醉复合椎旁神经阻滞与插管全身麻醉胸科手术中的比较

非插管全身麻醉复合椎旁神经阻滞与插管全身麻醉在患儿胸腔镜辅助下胸科手术中的比较

贵州医科大学麻醉与心脏电生理课题组  

翻译：吴学艳 编辑：陈锐 审校：曹莹

HOLIDAY   背景  

本研究旨在探讨非插管全身麻醉联合椎旁神经阻滞(PVNB)能否促进在胸腔镜辅助下行胸科手术(VATS)患儿的康复。 

HOLIDAY   方法  

一项随机对照试验，纳入60名3-8岁择期在胸腔镜辅助下行胸科手术的患儿。患儿进行随机分配，分别接受非插管全身麻醉联合椎旁神经阻滞或插管全身麻醉（1:1比例）。主要观察指标是术后住院时间的长短。次要观察指标包括苏醒时间、谵妄发生率、首次进食时间、首次下床活动时间、疼痛评分和院内并发症。

HOLIDAY   结果  

非插管组术后住院时间明显短于插管组(4d[IQR，4~6] vs 5d[IQR，5~8]，95%CI为0~2；P=0.013)。与插管组相比，非插管组在谵妄发生率(优势比[OR]3.39，95%CI 1.01~11.41；P=0.043)、苏醒时间、PACU停留时间、首次进食时间、首次下床活动时间、疼痛评分和舒芬太尼用量(术后6h和12h)均明显低于插管组。相比之下，插管组气道并发症的发生率高于非插管组(27.6% VS 6.9%，P=0.037)。两组间PONV，气胸等并发症的发生率无统计学意义。

          HOLIDAY 结论

尽管还需要进一步的多中心研究，但非插管全身麻醉联合椎旁神经阻滞可促进胸腔镜辅助下胸科手术患儿的康复。

HOLIDAY   原始文献来源  

Wei W, Fan Y, Liu W, et al. Combined non-intubated anaesthesia and paravertebral nerve block in comparison with intubated anaesthesia in childrenundergoing video-assisted thoracic surgery. Acta Anaesthesiol Scand. 2020;64:810–818.

Combined non-intubated anaesthesia and paravertebral nerve block in comparison with intubated anaesthesia in children undergoing video-assisted thoracic surgery

Abstract

Background:This study is to investigate if non-intubated anaesthesia combined with paravertebral nerve block (PVNB) can enhance recovery in children undergoing video-assisted thoracic surgery (VATS).

Methods:A randomized controlled trial including 60 patients aged 3 to 8 years old who underwent elective VATS was performed. They were randomly assigned to receive non-intubated anaesthesia combined with PVNB or general anaesthesia with tracheal intubation (1:1 ratio). The primary outcome was the length of postoperative in-hospital stay. The secondary outcomes included emergence time, the incidence of emergence delirium, time to first feeding, time to first out-of-bed activity, pain score and in-hospital complications.

Results:The non-intubated group had shorter postoperative in-hospital stay than the control group (4 days [IQR, 4-6] vs 5 days [IQR, 5-8], 95% CI 0-2; P = .013). When compared to the control group, the incidence of emergence delirium (odds ratio [OR] 3.39, 95% CI 1.01-11.41; P = .043), emergence time, duration in the PACU, time to first eating food, first out-of-bed activity, pain score and consumption of sufentanil (at 6 and 12 hours after surgery) were decreased in the intervention group. In contrast, the incidence of airway complications was higher in the control than the intervention group (27.6% vs 6.9%, P = .037). There was no statistical significance in the occurrence of PONV, pneumothorax and other complications between the two groups.

Conclusion:Non-intubated anaesthesia combined with PVNB enhances recovery in paediatric patients for video-assisted thoracic surgery although further multi-centre study is needed.