翻译：吴学艳 编辑：陈锐 审校：曹莹
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。
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
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.
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