目的 探讨无阿片保留自主呼吸麻醉策略在胸腔镜下胸交感神经切断治疗手汗症中的临床效果。 方法 手汗症患者择期行喉罩全麻下手术治疗93例，随机分为对照组（C组）和观察组（O组）。C组采用丙泊酚+舒芬太尼+顺式阿曲库铵麻醉，O组采用丙泊酚+右美托咪定+胸椎旁阻滞麻醉。观察两组患者麻醉前（T₁）、切皮即刻（T₂）、术毕（T₃）、出手术室（T₄）生命体征及血气指标变化，记录患者苏醒即刻（P₁）、出手术室（P₂）、术后2 h（P₃）、术后6 h（P₄）、术后24 h（P₅）的视觉模拟评分（visual analogue scale，VAS），并记录患者围术期麻醉相关并发症发生情况、术后恢复时间和患者对麻醉的满意度。 结果 围术期未发生手术中断或更改麻醉方式病例。两组各时点镇静及疼痛指数的变化差异无统计学意义（P > 0.05），O组P₁、P₄时点VAS评分较高，T₂时点PH较低，PCO₂、BG较高（P < 0.05），围术期高血压、心动过速的发生率较高（P < 0.05）。两组术后恢复时间及患者满意度的比较差异无统计学意义（P > 0.05）。 结论 在手汗症日间手术中联合无阿片及保留自主呼吸麻醉策略安全可行，但该技术在临床应用无明显优势。

Objective This study aime to investigate the clinical status of opioid free with spontaneous breathing anesthesia in the treatment of palmar hyperhidrosis through thoracic sympathectomy under thoracoscopy. Methods A total of 93 patients with palmar hyperhidrosis who underwent elective surgery with general anesthesia were randomly divided into control group （group C） and observation group （group O）. In group C， patients were treated with propofol， sufentanil， and cisatracurium. In group O， patients were anesthetized with propofol， dexmedetomidine， and thoracic paravertebral block. The changes of vital signs and blood gas indicators between two groups before anesthesia （T₁）， at the time of skin incision （T₂）， after surgery （T₃）， and leaving the operating room （T₄） were observed. The visual analog scale （VAS） of patients immediately after awakening （P₁）， leaving the operating room （P₂）， 2 hours （P₃）， 6 hours （P₄）， and 24 hours after surgery （P₅） were recorded. The occurrence of perioperative anesthesia related complications， postoperative recovery time and patients′ satisfaction were also observed. Results There was no case of surgical interruption due to anesthesia or anesthesia methods changing during the perioperative period. And no significant difference in the changes of sedation and pain index was observed between two groups （P > 0.05）. However， in group O， the VAS scores were higher at P₁ and P₄ （P > 0.05）， PH was lower， PCO₂ and BG were higher at T₂ （P < 0.05）， and the incidence of perioperative hypertension and tachycardia was higher （P < 0.05）. There were no statistically significant difference in postoperative recovery time and patient′s satisfaction between these two groups （P > 0.05）. Conclusion The implementation of opioid free with spontaneous breathing anesthesia strategy in day surgery for palmar hyperhidrosis is safe and feasible but the application of this strategy has no significant advantages in clinical practice of day surgery.