腹腔镜结直肠癌手术的麻醉管理

发布时间：2018-10-11 13:36

【摘要】：目的总结腹腔镜结直肠癌手术麻醉管理的经验。方法回顾性分析2007年10月~2009年6月178例腹腔镜下结直肠癌手术的麻醉资料,其中结肠癌根治手术76例,直肠癌根治手术102例,98例(55.1%)合并一种以上的全身性疾病。均采用气管内插管全身麻醉,术中监测无创血压(blood pressure,BP)、心率(heart rate,HR)、脉搏血氧饱和度(saturation of pulse oxygen,SpO2)、呼气末CO2分压(end-tidal carbon dioxide pressure,PETCO2)。结果气腹后10min平均动脉压(mean arterial pressure,MAP)、HR、PETCO2较气腹前显著性升高,经处理,气腹后30min MAP、HR明显降低,PETCO2无明显升高。术中130例(73.0%)使用一种以上的血管活性药,61例(34.3%)使用2种以上的血管活性药。132例在手术间或麻醉恢复室拔除气管导管,停止麻醉至拔除气管导管时间(39±25)min(6~140min),恢复室停留时间(71±36)min(25~209min)。46例(25.8%)带气管导管送入ICU病房。结论术前全面评估病人,完善围术期监测,加强术中管理,及时纠正处理合并症,腹腔镜结直肠癌手术患者的麻醉是安全的。
[Abstract]:Objective to summarize the experience of anesthesia management in laparoscopic colorectal cancer surgery. Methods from October 2007 to June 2009, 178 cases of laparoscopic surgery for colorectal cancer were retrospectively analyzed, including 76 cases of radical resection of colon cancer, 102 cases of radical resection of rectal cancer, 98 cases (55.1%) of which were complicated with more than one type of systemic disease. Noninvasive blood pressure (blood pressure,BP), heart rate (heart rate,HR), pulse oxygen saturation (saturation of pulse oxygen,SpO2) and end-expiratory CO2 partial pressure (end-tidal carbon dioxide pressure,PETCO2) were monitored by endotracheal intubation. Results after pneumoperitoneum, the mean arterial pressure of 10min (mean arterial pressure,MAP) and HR,PETCO2 were significantly higher than those before pneumoperitoneum. After treatment, the 30min MAP,HR of pneumoperitoneum decreased significantly, but PETCO2 did not. 130 cases (73.0%) were treated with more than one vasoactive drug and 61 cases (34.3%) with more than 2 vasoactive drugs. The time from anaesthesia to extubation (39 卤25) min (6~140min) and the time to stay in the recovery chamber (71 卤36) min (25~209min). 46 cases (25.8%) were transferred to ICU ward with trachea catheter. Conclusion preoperative comprehensive evaluation of patients, improvement of perioperative monitoring, strengthening of intraoperative management, timely correction of complications, laparoscopic colorectal cancer surgery patients anesthetic is safe.
【作者单位】：北京大学第三医院麻醉科;航天中心医院麻醉科;
【分类号】：R614.2

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