保留自主呼吸的胸科手术麻醉管理专家共识

doi:10.3969/j.issn.1006-5725.2025.13.001

Abstract

Abstract:

Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients. Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function， the writing group of the "Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration" has formulated elaborate guidelines regarding indications and contraindications， preoperative evaluation， anesthesia implementation， common complications， and treatment strategies. This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements. The objective is to standardize the rational application of this anesthesia method.

Key words: spontaneous respiration, thoracic anesthesia, expert consensus

CLC Number:

R614

Qisen FAN,Lan LAN,Jingxiang WU,Yuan QIU,Guiping XU,Jiang WANG,Duozhi WU,Jinhui LUO,Jian RAN,Yingfen LI,Peng PAN,Bing ZHANG,Yuelan ZHOU,Yiwen ZHANG,Xuebing XU,Yatao LIU,Yingbin WANG,Yan WANG,Yulong WANG,Youyang HU,Shoushi WANG,Hongwei MENG,Haixia XU,Peijia TANG,Xiaoxue ZHUANG,Canzhou. ZHANG. Consensus of experts on the management of thoracic anesthesia with spontaneous respiration[J]. The Journal of Practical Medicine, 2025, 41(13): 1945-1951.

Figures/Tables 1

References 43

[1]	HAN B， ZHENG R， ZENG H， et al. Cancer incidence and mortality in China， 2022［J］. J Natl Cancer Cent，2024，4（1）：47-53. doi:10.1016/j.jncc.2024.01.006 doi: 10.1016/j.jncc.2024.01.006
[2]	DUMA N， SANTANA-DAVILA R， MOLINA J R. Non-Small Cell Lung Cancer： Epidemiology， Screening， Diagnosis， and Treatment［J］. Mayo Clin Proc，2019，94（8）：1623-1640. doi:10.1016/j.mayocp.2019.01.013 doi: 10.1016/j.mayocp.2019.01.013
[3]	赫捷，李霓，陈万青，等. 中国肺癌筛查与早诊早治指南（2021，北京）［J］. 中国肿瘤， 2021，30（2）：81-111.
[4]	SOLIMAN B G， NGUYEN D T， CHAN E Y，et al. Impact of da Vinci Xi robot in pulmonary resection［J］ . J Thorac Dis，2020，12（7）：3561-3572. doi:10.21037/jtd-20-720 doi: 10.21037/jtd-20-720
[5]	LI S， JIANG L， ANG K L，et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules［J］. Eur J Cardiothorac Surg，2017，51（4）：689-693.
[6]	HUANG Y， BO Y， LI Y， et al. The impact of tubeless anesthesia versus intubated anesthesia on cerebral oxygen saturation and postoperative cognitive function in patients undergoing video-assisted thoracoscopic surgery： A randomized trial［J］. J Thorac Dis，2022，14（10）：4012-4030. doi:10.21037/jtd-22-1165 doi: 10.21037/jtd-22-1165
[7]	WEN Y， LIANG H， QIU G， et al. Non-intubated spontaneous ventilation in video-assisted thoracoscopic surgery： A meta-analysis［J］. Eur J Cardiothorac Surg，2020，57（3）：428-437.
[8]	HUNG W T， HUNG M H， WANG M L，et al. Nonintubated Thoracoscopic Surgery for Lung Tumor： Seven Years' Experience With 1，025 Patients［J］. Ann Thorac Surg，2019，107（6）：1607-1612. doi:10.1016/j.athoracsur.2019.01.013 doi: 10.1016/j.athoracsur.2019.01.013
[9]	VANNI G， TACCONI F， SELLITRI F， et al. Impact of awake videothoracoscopic surgery on postoperative lymphocyte responses［J］. Ann Thorac Surg， 2010，90（3）：973-978. doi:10.1016/j.athoracsur.2010.04.070 doi: 10.1016/j.athoracsur.2010.04.070
[10]	HSIUNG P Y， SHIH P Y， WU Y L， et al. Effects of nonintubated thoracoscopic surgery on postoperative neurocognitive function： a randomized controlled trial［J］. Eur J Cardiothorac Surg，2024，65（1）：ezad434. doi:10.1093/ejcts/ezad434 doi: 10.1093/ejcts/ezad434
[11]	WANG L， WANG D， ZHANG Y. Comparison of postoperative pulmonary complications and intraoperative safety in thoracoscopic surgery under non-intubated versus intubated anesthesia： a randomized， controlled， double-blind non-inferiority trial［J］. Updates Surg，2024，76（8）：2863-2873. doi:10.1007/s13304-024-01935-y doi: 10.1007/s13304-024-01935-y
[12]	ZHENG Y F， JIANG Y S， LIU H T， et al. Thoracic paravertebral nerve block combined laryngeal mask airway with preservation of spontaneous breathing can accelerate postoperative recovery［J］. Eur Rev Med Pharmacol Sci，2023，27（22）：10875-10883.
[13]	UDELSMAN B V， JANG A， MUNIAPPAN A， et al. Perioperative morbidity and 3-year survival in non-intubated thoracoscopic surgery： a propensity matched analysis［J］. J Thorac Dis，2024，16（2）：1180-1190. doi:10.21037/jtd-23-591 doi: 10.21037/jtd-23-591
[14]	KONG X G， WANG K， WEI Y T， et al. Nonintubated spontaneous ventilation versus intubated mechanical ventilation anesthesia for video-assisted thoracic surgery in terms of perioperative complications and practitioners' workload assessments： a pilot randomized control study［J］. BMC Anesthesiol，2024，24（1）：99. doi:10.1186/s12871-024-02481-1 doi: 10.1186/s12871-024-02481-1
[15]	SZABO Z， FABO C， SZARVAS M， et al. Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery： A New Anesthesiologic Method Based on 141 Cases over Three Years［J］. J Clin Med，2023，12（20）：6457. doi:10.3390/jcm12206457 doi: 10.3390/jcm12206457
[16]	LIU Y J， HUNG M H， HSU H H， et al. Effects on respiration of nonintubated anesthesia in thoracoscopic surgery under spontaneous ventilation［J］. Ann Transl Med，2015，3（8）：107.
[17]	HE J， LIU J， ZHU C， et al. Expert consensus on tubeless video-assisted thoracoscopic surgery （Guangzhou）［J］. J Thorac Dis，2019，11（10）：4101-4108. doi:10.21037/jtd.2019.10.04 doi: 10.21037/jtd.2019.10.04
[18]	HE J， LIANG H， WANG W， et al. Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules： expert consensus and protocol （Guangzhou）［J］. Transl Lung Cancer Res，2021，10（8）：3503-3519.
[19]	GUYATT G， OXMAN A D， AKL E A， et al. GRADE guidelines： 1. Introduction-GRADE evidence profiles and summary of findings tables［J］. J Clin Epidemiol，2011，64（4）：383-394. doi:10.1016/j.jclinepi.2010.04.026 doi: 10.1016/j.jclinepi.2010.04.026
[20]	LIU J， LIANG H， CUI F， et al. Spontaneous versus mechanical ventilation during video-assisted thoracoscopic surgery for spontaneous pneumothorax： A randomized trial［J］. J Thorac Cardiovasc Surg，2022，163（5）：1702-1714.e7.
[21]	LI S， AI Q， LIANG H， et al. Nonintubated Robotic-assisted Thoracic Surgery for Tracheal/Airway Resection and Reconstruction： Technique Description and Preliminary Results［J］. Ann Surg，2022，275（2）：e534-e536. doi:10.1097/sla.0000000000004887 doi: 10.1097/sla.0000000000004887
[22]	SHAO G Q， PANG D Z， ZHANG J T， et al. Spontaneous ventilation anesthesia combined with uniportal and tubeless thoracoscopic sympathectomy in selected patients with primary palmar hyperhidrosis［J］. J Cardiothorac Surg，2022，17（1）：177. doi:10.1186/s13019-022-01917-4 doi: 10.1186/s13019-022-01917-4
[23]	SCHIEREN M， WAPPLER F， DEFOSSE J. Anesthesia for tracheal and carinal resection and reconstruction［J］. Curr Opin Anaesthesiol，2022，35（1）：75-81. doi:10.1097/aco.0000000000001082 doi: 10.1097/aco.0000000000001082
[24]	ZHOU Y， LIU H， WU X， et al. Spontaneous breathing anesthesia for cervical tracheal resection and reconstruction［J］. J Thorac Dis，2019，11（12）：5336-5342. doi:10.21037/jtd.2019.11.70 doi: 10.21037/jtd.2019.11.70
[25]	CUI W， HUANG D， LIANG H， et al. Tubeless video-assisted thoracoscopic surgery in mediastinal tumor resection［J］. Gland Surg，2021，10（4）：1387-1396. doi:10.21037/gs-20-682 doi: 10.21037/gs-20-682
[26]	YAOLIANG Z， ZHONGQIAO M， CHAO Y， et al. Non-intubated tracheal resection and reconstruction for a tracheal tumor in an 8-year-old child ［J］. J Cardiothorac Surg，2024，19（1）：468. doi:10.1186/s13019-024-02949-8 doi: 10.1186/s13019-024-02949-8
[27]	刘民强，洪凤珠，郭珊珊，等. 无阿片保留自主呼吸麻醉在手汗症日间手术中的应用［J］. 实用医学杂志， 2024，40（8）：1069-1073.
[28]	YANIK F， KARAMUSTAFAOGLU YA， YORUK Y. Outcomes of Non-intubated Versus Intubated Thoracoscopic Surgery for Primary Spontaneous Pneumothorax［J］. Surg Laparosc Endosc Percutan Tech，2023，33（5）：487-492. doi:10.1097/sle.0000000000001213 doi: 10.1097/sle.0000000000001213
[29]	支修益，刘伦旭. 中国胸外科围手术期气道管理指南（2020版）［J］. 中国胸心血管外科临床杂志， 2021，28（3）：251-262.
[30]	BAYRAM A S， CANDAN T， GEBITEKIN C. Preoperative maximal exercise oxygen consumption test predicts postoperative pulmonary morbidity following major lung resection［J］. Respirology，2007，12（4）：505-510. doi:10.1111/j.1440-1843.2007.01097.x doi: 10.1111/j.1440-1843.2007.01097.x
[31]	British Thoracic Society； Society of Cardiothoracic Surgeons of Great Britain and Ireland Working Party. BTS guidelines： guidelines on the selection of patients with lung cancer for surgery［J］. Thorax，2001，56（2）：89-108. doi:10.1136/thorax.56.2.89 doi: 10.1136/thorax.56.2.89
[32]	GENE L C， SHIRIN S， JOHN P G， et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery： ACCP evidenced-based clinical practice guidelines （2nd edition）［J］. Chest，2007，132（3 ）：161S-77S. doi:10.1378/chest.07-1359 doi: 10.1378/chest.07-1359
[33]	LICKER M J， WIDIKKER I， ROBERT J， et al. Operative mortality and respiratory complications after lung resection for cancer： impact of chronic obstructive pulmonary disease and time trends［J］. Ann Thorac Surg，2006，81（5）：1830-1837. doi:10.1016/j.athoracsur.2005.11.048 doi: 10.1016/j.athoracsur.2005.11.048
[34]	KRISTENSEN S D， KNUUTI J， SARASTE A， et al. 2014 ESC/ESA Guidelines on non-cardiac surgery： cardiovascular assessment and management： The Joint Task Force on non-cardiac surgery： cardiovascular assessment and management of the European Society of Cardiology （ESC） and the European Society of Anaesthesiology （ESA）［J］. Eur J Anaesthesiol，2014，31（10）：517-573.
[35]	CAO D， CHANDIRAMANI R， CAPODANNO D， et al. Non-cardiac surgery in patients with coronary artery disease： risk evaluation and periprocedural management［J］. Nat Rev Cardiol，2021，18（1）：37-57. doi:10.1038/s41569-020-0410-z doi: 10.1038/s41569-020-0410-z
[36]	BAHL V， HU H M， HENKE P K， et al. A validation study of a retrospective venous thromboembolism risk scoring method［J］. Ann Surg，2010，251（2）：344-350. doi:10.1097/sla.0b013e3181b7fca6 doi: 10.1097/sla.0b013e3181b7fca6
[37]	DETSKY M E， JIVRAJ N， ADHIKARI N K， et al. Will This Patient Be Difficult to Intubate？： The Rational Clinical Examination Systematic Review ［J］. JAMA，2020，323（12）：1194.
[38]	ROTH D， PACE NL， LEE A， et al. Bedside tests for predicting difficult airways： an abridged Cochrane diagnostic test accuracy systematic review［J］. Anaesthesia，2019，74（7）：915-928. doi:10.1111/anae.14608 doi: 10.1111/anae.14608
[39]	PATHONSAMIT C， TANTRAWORASIN A， POOPIPATPAB S， et al. Perioperative outcomes of non-intubated versus intubated video-assisted thoracoscopic surgery in different thoracic procedures： A propensity score-matched analysis［J］. BMC Anesthesiol，2022，22（1）：154. doi:10.1186/s12871-022-01667-9 doi: 10.1186/s12871-022-01667-9
[40]	LAN L， CEN Y， JIANG L， et al. Risk Factors for the Development of Intraoperative Hypoxia in Patients Undergoing Nonintubated Video-Assisted Thoracic Surgery： A Retrospective Study from a Single Center［J］. Med Sci Monit，2021，27：e928965. doi:10.12659/msm.928965 doi: 10.12659/msm.928965
[41]	GOLDENBERG N M， HARE G M. From the Journal archives： Understanding the mechanism（s） regulating hypoxic pulmonary vasoconstriction： how an early study has led to novel translational approaches［J］. Can J Anaesth，2014，61（2）：195-199. doi:10.1007/s12630-013-0086-5 doi: 10.1007/s12630-013-0086-5
[42]	黑子清，黄文起，刘克玄，等. 麻醉前应用抗胆碱能药物的广东省专家共识（2021版）［J］. 广东医学， 2021，42（11）：1290-1294.
[43]	ZHANG X， WANG D X， ZHANG Q， et al. Effect of intubation in the lateral position under general anesthesia induction on the position of double-lumen tube placement in patients undergoing unilateral video-assisted thoracic surgery： study protocol for a prospective， single-center， parallel group， randomized， controlled trial［J］. Trials，2023，24（1）：67. doi:10.1186/s13063-023-07075-9 doi: 10.1186/s13063-023-07075-9

等级	说明
证据等级
Ⅰ（高等级）	高质量的随机对照研究（randomized controlled trial, RCT）、权威指南以及高质量系统综述和Meta分析
Ⅱ（中等级）	有一定研究局限性的RCT研究（如无隐藏分组、未设盲、未报告失访）、队列研究、病例系列研究及病例－对照研究
Ⅲ（低等级）	病例报道、专家意见等
推荐等级
A（强推荐）	该方案大多数患者、医师和政策制定者都会采纳
B（中度推荐）	该方案大多数人会采纳，但仍有部分人不采纳，要结合患者具体情况作出体现其价值观和意愿的决定
C（弱推荐）	证据不足，需要患者、医师和政策制定者共同讨论决定

Consensus of experts on the management of thoracic anesthesia with spontaneous respiration

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 1

References 43

Related Articles 4

Recommended Articles

Metrics

Comments

[1]	Wei LI,Quan LIU,Lanji HUANG,Li JIAO,Jian TANG,Shushan. JIA. Effect of esketamine on respiration during single-port thoracoscopic surgery under general anesthesia with preserved spontaneous respiration [J]. The Journal of Practical Medicine, 2024, 40(13): 1859-1863.
[2]	ZHONG Xingming.. Discussing on controversial issues in diagnosis and treatment of recurrent spontaneous abortion [J]. The Journal of Practical Medicine, 2022, 38(9): 1045-1050.
[3]	LI Yanqiu, YAO Junpeng, YAN Xiangyun, YANG Yuqing, CHEN Min, LI Ying. . Quality evaluation and content analysis of clinical practice guidelines and expert consensus for chronic con⁃ stipation based on AGREEⅡ [J]. The Journal of Practical Medicine, 2022, 38(19): 2377-2383.
[4]	PAN Longfei, PEI Honghong, HONG Xin, WANG Liming, ZHANG Zhengliang, BAI Zhenghai.. Diagnosis and treatment of hypertriglyceridemic acute pancreatitis [J]. The Journal of Practical Medicine, 2021, 37(20): 2569-2574.