两种麻醉方法胸腔镜肺癌术后病人疼痛及相关报告结局的比较

Comparison of pain-related patient-reported outcomes in thoracoscopic surgery for lung cancer with two anesthesia methods

摘要:

目的:比较非插管自主呼吸和双腔支气管插管麻醉胸腔镜肺癌切除术后病人疼痛及相关报告结局的差异。方法:选取拟行胸腔镜肺癌切除手术的215例病人,其中非插管自主呼吸麻醉110例(非插管组),双腔支气管插管麻醉105例(插管组)。麻醉恢复期使用重症监护疼痛评估工具观察疼痛行为,术后第1天使用国际疼痛结果问卷调查病人的切口疼痛程度及疼痛影响,出麻醉恢复室前、术后第1、第2天采用数字评分量表询问切口疼痛以及咽痛、声嘶和头晕等麻醉相关症状。结果:麻醉恢复期两组病人疼痛均为轻度；非插管组咽痛和声嘶发生率为15.35%和6.36%,低于插管组的29.52%和15.45%(P<0.05)。术后第1天非插管组重度疼痛、恶心和头晕发生率为16.36%、7.27%和10.91%,低于插管组的54.29%、21.90%和35.24%(P<0.05)；非插管组病人术后疼痛对床上活动、深呼吸、咳嗽的影响及疼痛导致的焦虑程度较低,两组差异有统计学意义(P<0.05)。结论:非插管自主呼吸麻醉胸腔镜肺癌术后病人疼痛及报告结局更好,术后咽痛和声嘶发生率较低。

Abstract:

Objective: To compare the pain-related patient-reported outcomes in lung cancer patients undergoing thoracoscopic surgery with non-intubated with spontaneous ventilation versus double-lumen endotracheal intubated anesthesia. Methods: A total of 215 lung cancer patients who underwent thoracoscopic surgery were enrolled. Of these, 110 patients received non-intubated anesthesia with spontaneous ventilation, while 105 double-lumen endobronchial intubated anesthesia. Pain during anesthesia recovery period were observed using the Critical Care Pain Observation Tool. Pain intensity and pain interference were assessed on the first postoperative day using the International Pain Outcomes Questionnaire. On the first two postoperative days, anesthesia-related symptoms such as sore throat, hoarseness, and dizziness were evaluated using a Numeric Rating Scale. Results: During the anesthesia recovery period, pain severity in both groups was mild, the incidences of sore throat and hoarseness in non-intubated group were significantly lower than in the intubated group (15.35% and 6.36%, vs 29.52% and 15.45%, P<0.05). On the first postoperative day, the incidences of severe pain, nausea and dizziness in non-intubated group were significantly lower than in intubated group (16.36%, 7.27% and 10.91%, vs 54.29%, 21.90% and 35.24%, P<0.05). Significant lower levels in the pain interference with activities in bed , deep breathing, coughing, and anxious in the non-intubated group were also observed (P<0.05). Conclusion: Patients undergoing video-assisted thoracoscopic lung cancer surgery under non-intubated anesthesia with spontaneous ventilation report better pain-related outcomes and a lower incidence of postoperative hoarseness and sore throat.