Evaluation Of The Effect Of Spontaneous Ventilation Video-Assisted Thoracic Surgery On Rapid Rehabilitation Of Patients With Non-small Cell Lung Cancer

Objective:This study is to explore the safety and feasibility of Spontaneous Ventilation Video-Assisted Thoracic Surgery(SV-VATS)in the treatment of patients with non-small cell lung cancer,and to explore the advantages of retained spontaneous ventilation in the enhance recovery after surgery(ERAS)Methods:Sixty patients with non-small cell lung cancer who underwent lobectomy and systemic lymph node dissection in the Department of Thoracic Surgery of GuiZhou Provincial People Hospital from December 2017 to December 2019 were selected,which divided into the retained spontaneous ventilation group(hereinafter referred to as the SV group)and double-lumen endotracheal intubation group(hereinafter referred to as OLV group),according to the random number remainder grouping method.Each group have thirty patients and all patients were performed by the same surgeons and anesthesiologists in the same group.The relevant indexes of patients during perioperative period were collected.Preoperative evaluation indicators age,gender,body mass index(BMI),American Society of Anesthesiology(ASA),forced expiratory volume in first second(FEV1),peak expiratory flow(PEF)and preoperative serum-related inflammatory indicators,etc;intraoperative evaluation indicators:surgical field exposure satisfaction,surgical anesthesia induction time,surgical time,intraoperative anesthetic drugs use amount,intraoperative blood loss,intraoperative maximum end-respiratory carbon dioxide partial pressure,intraoperative minimum blood oxygen saturation,etc;postoperative evaluation indicators postoperative wake-up time,postoperative fasting time,postoperative bedtime,indwelling time of closed chest drainage tube,postoperative hospital stay,serum-related inflammatory indexes on the first day after surgery,peak postoperative respiratory flow velocity PEF value,postoperative complications,etc.Perioperative indexes were collected for statistical analysisResults:Patients in both groups successfully completed the operation without transition to anesthesia,thoracotomy or unplanned surgery.There were no statistically significant differences in general data before surgery between the two groups include age,gender,BMI,FEV1,and ASA(P>0.05).There were no significant differences in the surgical field exposure satisfaction score,operation time,intraoperative blood loss,and intraoperative minimum oxygen saturation between the two groups(P>0.05).But the surgery anesthesia induction time(14.80±1.40 VS 19.80±2.19 min,P<0.05)and the amount of anesthetic drugs used in the SV group was significantly less than the OLV group(P<0.05);The highest end-respiratory carbon dioxide partial pressure(50.97 ± 2.44 VS 34.47± 2.56 mmHg)was significantly higher in the SV group than in the OLV group(P<0.05).It shows the wake-up time(44.00 ±7.24 VS 63.83 ± 17.15 min,P<0.05),postoperative fasting time(6.42± 0.84 VS 13.63± 3.05 h,P<0.05),and post-bed time(10.33 ± 1.58 VS 24.23 ± 1.81 h,P<0.05),length of stay(6.53± 1.14 VS 7.77±1.57 d,P=0.001)in the SV group was significantly shorter than the OLV group(P<0.05);The SV group(7.98± 0.64)was reduced compared with the OLV group(8.88± 0.41)in patients’ hospitalization costs(10,000 yuan).There were no different in hoarseness,atelectasis,subcutaneous emphysema,cough,pulmonary infection and other complications between the two groups(P>0.05).But the incidence of nausea,vomiting,and sore throat in the SV group were lower than that in the OLV group(P<0.05).All patients were followed after the operation,improved the evaluation of quality of life of FACT-L lung cancer.It showed that the physiological state,additional cases of lung cancer and the overall quality of life in SV group were better than the OLV group,and there were no statistical difference in social/family,functional status,and emotional status Significance(P>0.05)between two groupsConclusion:Spontaneous respiratory anesthesia applied to thoracoscopy for non-small cell lung cancer can reduce the dosage of anesthetic drugs,reduce the side effects of anesthetic drugs,avoid tracheal intubation and mechanical ventilation,reduce intubation stimulation and mechanical ventilation-related lung injury,and reduce the incidence of related complications in general anesthesia intubation.It can promote patients to eat early,move early,reduce the length of hospital stay after surgery,reduce the cost of hospitalization,and improve the quality of life after surgery,reduce perioperative complications and promote early recovery of patients.The clinical application of reserved spontaneous breathing thoracoscopy in the treatment of non-small cell lung cancer requires strict grasp of surgical indications and patient selection For patients with early lesions,spontaneous breathing anesthesia is safe and effective.