【摘要】 目的 依据加速康复外科理念，结合可视化技术和微创外科的快速发展，本研究采用Tubeless无管麻醉策略代替传统双腔导管插管麻醉策略，探讨该方法在胸腔镜下肺癌根治术的安全性及可能带来的临床利弊。方法 选取2019年1月至2023年6月安阳市肿瘤医院收治的60例肺癌患者作为研究对象，按照随机数字表法分为Tubeless无管麻醉组（T组）和双腔导管插管麻醉组（D组），每组30例。麻醉均采用全身麻醉。T组采用Tubeless无管麻醉方法，喉罩置入保留自主呼吸的全身静脉麻醉联合多种神经阻滞（包括胸椎旁神经阻滞、切口局部麻醉药浸润、肺胸膜表面阻滞、胸腔内膈神经及迷走神经阻滞）。D组采用双腔导管插管方法，单肺通气下的静吸复合麻醉联合多种神经阻滞。分别在麻醉诱导前（T₁）、手术开始即刻（T₂）、手术开始30 min（T₃）、术毕（T₄）采集患者的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO₂）、呼气末二氧化碳分压（PetCO₂）、动脉血气等临床指标和围手术期相关指标如术中出血量、手术时间、麻醉恢复室（PACU）停留时间、住院时间、住院费用以及术后并发症发生率等指标。结果 两组患者均无中转开胸，各时间点未出现严重并发症，顺利完成胸腔镜手术。整体分析结果显示，两组患者的MAP、HR、pH、PaCO₂、PaO₂时间、组间比较，MAP、HR、pH、PaCO₂的交互效应比较，差异有统计学意义（P<0.05）。T₂、T₃时，两组患者的MAP、HR、p H低于本组T₁时，而PaO₂高于本组T₁时，T组的PaCO₂高于本组T₁时，T组的MAP、HR、PaCO₂高于D组，pH、Pa O₂低于D组，差异有统计学意义（P<0.05）。T组患者术后并发症总发生率低于D组，PACU停留时间、住院时间短于D组，住院总费用少于D组，差异有统计学意义（P<0.05）。结论 Tubeless无管麻醉虽会发生允许性高CO₂血症，但无低氧血症发生，减少了阿片类药物的使用，其在胸腔镜手术中是安全、可行的。同时其在肺保护和促进患者加速康复方面具有明显优势，优化了医疗资源和减少了并发症发生率。更多还原

【Abstract】 Objective Based on the concept of enhanced recovery after surgery and in combination with the rapid development of visualization technology and minimally invasive surgery, this study adopted the Tubeless anesthesia strategy instead of the traditional double-lumen catheter intubation anesthesia strategy to explore the safety of this method in thoracoscopic radical surgery for lung cancer and the possible clinical advantages and disadvantages. Methods Sixty lung cancer patients admitted to Anyang Cancer Hospital from January 2019 to June 2023 were selected as the research subjects, and they were divided into the Tubeless anesthesia group（group T） and the double-lumen catheter intubation anesthesia group（group D）according to the random number table method, with 30 cases in each group. General anesthesia was used for all cases. Group T was treated with Tubeless anesthesia, total intravenous anesthesia with laryngeal mask placement and preservation of spontaneous breathing was combined with multiple nerve blocks（including paravertebral nerve block, local anesthetic infiltration at the incision, pulmonary pleural surface block, phrenic nerve and vagus nerve block in the thoracic cavity）.Group D was treated with double-lumen catheter intubation, combined with intravenous-inhalation anesthesia under one-lung ventilation and multiple nerve blocks. Clinical indicators such as mean arterial pressure（MAP）, heart rate（HR）, pulse oxygen saturation（SPO₂）, end-tidal carbon dioxide partial pressure（PetCO₂）, and arterial blood gas before anesthesia induction（T₁）, immediately after the start of the surgery（T₂）, 30 minutes after the start of the surgery（T₃） and at the end of the surgery（T₄）, as well as perioperative related indicators such as intraoperative blood loss, operation time, postanesthesia care unit（PACU） stay time, length of hospital stay, hospitalization cost and occurrence of postoperative complications of the patients were collected. Results Neither group of patients was converted to thoracotomy, and no serious complications occurred at each time point. Thoracoscopic surgery was successfully completed. The overall analysis results showed that there were statistically significant differences in time and group comparison of MAP, HR, pH, PaCO₂, PaO₂, and the interaction effects of MAP, HR, pH, and PaCO₂ between the two groups of patients（P<0.05）. At T₂ and T₃, the MAP, HR and pH of the two groups of patients were lower than those at T₁, while the PaO₂ was higher than that at T₁, the PaCO₂ in group T was higher than that at T₁, the MAP, HR and PaCO₂ in group T were higher than those in group D, while the pH and PaO₂ were lower than those in group D, the differences were statistically significant（P<0.05）. The total incidence of postoperative complications in group T was lower than that in group D, the PACU stay time and hospital stay were shorter than those in group D, and the total hospitalization cost was less than that in group D, the differences were statistically significant（P<0.05）. Conclusion Although Tubeless anesthesia may cause permissibility of hyper CO₂, no hypoxemia occurs, and the use of opioids is reduced. It is safe and feasible in thoracoscopic surgery. At the same time, it has obvious advantages in lung protection and promoting patients’ accelerated recovery, optimizing medical resources and reducing the incidence of complications.更多还原