發(fā)布時(shí)間：2018-01-26 21:47

  本文關(guān)鍵詞： 漏斗胸 NUSS 喉罩 非氣管內(nèi)插管 氣管內(nèi)插管　出處：《南方醫(yī)科大學(xué)》2017年博士論文　論文類型：學(xué)位論文

【摘要】：背景漏斗胸是最常見的先天性胸廓畸形,占所有胸壁畸形的9 0%,最理想的治療選擇是外科手術(shù)。氣管內(nèi)插管全身麻醉下NUS S矯治術(shù)是目前國(guó)內(nèi)外漏斗胸的主要治療手段。非氣管內(nèi)插管麻醉具有創(chuàng)傷小、術(shù)后并發(fā)癥少的優(yōu)點(diǎn),因此被越來越多地應(yīng)用在胸部手術(shù)麻醉中。目的(1)探索漏斗胸NU S S矯治術(shù)在喉罩行非氣管內(nèi)插管麻醉下實(shí)施的安全性和可行性;(2)對(duì)比喉罩非氣管內(nèi)插管與氣管內(nèi)插管麻醉下漏斗胸NU S S矯治術(shù)的效果。方法(2)從20 1 5年7月至20 1 5年1 2月對(duì)符合納入標(biāo)準(zhǔn)的3 0例漏斗胸患者在使用喉罩行非氣管內(nèi)插管全身麻醉下實(shí)施NUS S矯治術(shù)。收集臨床數(shù)據(jù)并進(jìn)行分析。(3)從2 0 1 5年1 0月至2 0 1 6年9月將符合標(biāo)準(zhǔn)的6 4例漏斗胸患者隨機(jī)分為喉罩組和氣管內(nèi)插管組,分別在喉罩非氣管內(nèi)插管和氣管內(nèi)插管麻醉下實(shí)施漏斗胸NUSS矯治術(shù)。收集臨床數(shù)據(jù)并進(jìn)行分析。結(jié)果(1)所有患者均成功完成漏斗胸N U S S矯治術(shù),平均手術(shù)時(shí)長(zhǎng)為79.9 6±4 5.3 7分鐘,平均失血量為8.1±9.3 0ml,平均術(shù)后住院時(shí)間為4.1 3 ±1.3 0天。血流動(dòng)力學(xué)在整個(gè)手術(shù)過程中都維持穩(wěn)定。2例患者術(shù)后出現(xiàn)惡心,1例患者出現(xiàn)喉嚨痛。疼痛評(píng)分在術(shù)后第一日平均為3.5 ±1.1,隨后逐漸下降。無中轉(zhuǎn)為開放手術(shù)、胃食管反流、住院死亡病例。(2)喉罩組與氣管內(nèi)插管組對(duì)比,在年齡、性別、Haller指數(shù)、麻醉順利程度、手術(shù)順利程度、置入鋼板數(shù)量、手術(shù)時(shí)長(zhǎng)、失血量、手術(shù)相關(guān)并發(fā)癥、住院時(shí)間、矯治效果、血流動(dòng)力學(xué)、圍手術(shù)期超敏C-反應(yīng)蛋白、術(shù)后疼痛方面兩組之間差異均無統(tǒng)計(jì)學(xué)意義,P0.0 5。所有患者均成功完成漏斗胸NUSS矯治術(shù),無中轉(zhuǎn)為開放手術(shù)、胃食管反流、住院死亡病例。喉罩組3例患者在麻醉醫(yī)生3次嘗失敗后中轉(zhuǎn)為氣管內(nèi)插管。兩組均未發(fā)生術(shù)中氣道裝置移位。結(jié)論(1)漏斗胸NU S S矯治術(shù)可以在喉罩行非氣管內(nèi)插管全身麻醉下被安全、有效地實(shí)施。(2)漏斗胸NUS S矯治術(shù)可以在喉罩行非氣管內(nèi)插管和氣管內(nèi)插管兩種麻醉方式下安全有效地完成,其手術(shù)過程、矯治結(jié)果、術(shù)后并發(fā)癥不受這兩種麻醉方式的影響,手術(shù)醫(yī)生和麻醉醫(yī)生可以根據(jù)自身的經(jīng)驗(yàn)和患者的具體情況進(jìn)行選擇。
[Abstract]:Background the funnel chest is the most common congenital thoracic malformation, accounting for 9 0% of all chest wall deformities. The best choice of treatment is surgery. NUS S is the main treatment method of funnel chest at home and abroad under general anesthesia of endotracheal intubation. Non-endotracheal intubation anesthesia has little trauma. The advantages of less postoperative complications. Objective 1) to explore the safety and feasibility of NUS correction of funnel chest under non-tracheal intubation anesthesia in laryngeal mask. (2) to compare the effect of intratracheal intubation of larynx mask with that of endotracheal intubation under endotracheal intubation anesthesia. From July to December of 2015, 30 patients with funnel chest who met the inclusion criteria were treated with NUS under general anesthesia under non-tracheal intubation with laryngeal mask. S Orthodontics. Collection and analysis of clinical data. 3) from October 2005 to September 2006, 64 patients with funnel chest were randomly divided into laryngeal mask group and endotracheal intubation group. NUSS correction of funnel chest was performed under laryngeal mask non-tracheal intubation and endotracheal intubation respectively. Clinical data were collected and analyzed. All the patients were successfully treated with N U S S of funnel chest. The mean operative time was 79.96 鹵45.37 minutes and the average blood loss was 8.1 鹵9.30 ml. The mean postoperative hospitalization time was 4.13 鹵1.30 days. The hemodynamics remained stable throughout the operation in 2 patients with postoperative nausea. One patient developed a sore throat. The average pain score was 3.5 鹵1.1 on 1st, and then decreased gradually. There was no conversion to open surgery and gastroesophageal reflux. The laryngeal mask group was compared with the endotracheal intubation group in terms of age, sex, Haller index, anesthesia, surgical success, the number of plates placed, the length of operation, and the amount of blood lost. There was no significant difference between the two groups in terms of operative complications, hospital stay, curative effect, hemodynamics, perioperative hypersensitive C-reactive protein and postoperative pain. P0.05. all patients successfully completed funnel chest NUSS correction, no conversion to open surgery, gastroesophageal reflux. 3 patients in laryngeal mask group were converted to endotracheal intubation after three failed anaesthesiologists. There was no airway device shift during operation in both groups. The Nu S S correction of funnel chest can be safely performed under general anesthesia without endotracheal intubation in laryngeal mask. NUS S correction of funnel chest can be performed safely and effectively under the two anesthesia modes of laryngeal mask, non-tracheal intubation and endotracheal intubation. The postoperative complications are not affected by the two anesthetic methods, the surgeon and the anesthesiologist can choose according to their own experience and the patient's specific situation.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R655

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