胸、腹腔镜联合微创食管癌根治术的麻醉管理

发布时间：2018-12-06 14:25

【摘要】：目的总结胸、腹腔镜联合微创食管癌根治术的麻醉管理经验。方法 2013年5~11月12例双腔支气管内插管静吸复合全麻下行胸、腹腔镜联合微创食管癌根治术。麻醉诱导采用丙泊酚、芬太尼和顺苯磺酸阿曲库铵静脉注射,插入左侧双腔支气管导管,纤维支气管镜检查定位。术中吸入七氟烷和静脉持续输注瑞芬太尼维持麻醉。胸腔镜操作中行左侧单肺通气(one-lung ventilation,OLV)。记录麻醉诱导前、麻醉诱导后、OLV前、OLV后30 min以及手术结束时等不同时点SBP、DBP、MAP、HR、Pa O2、Pa CO2和Ppeak值。结果 12例均完成胸、腹腔镜联合微创食管癌根治术。手术时间(425.7±90.1)min,麻醉时间(497.3±84.6)min。术中共输液(3020±606)ml,其中晶体液(2020±527)ml,胶体液(1000±316)ml,2例各输入红细胞悬液400 ml;术中出血量(204±80)ml,尿量(700±231)ml。与麻醉诱导前相比,SBP在麻醉诱导后、OLV前和手术结束时有统计学差异(q=7.607,P0.05;q=4.890,P0.05;q=3.713,P0.05),MAP在麻醉诱导后有统计学差异(q=5.560,P0.05);不同时点DBP、HR均无显著性差异(F=2.31,P=0.070;F=0.45,P=0.770)。与麻醉诱导后相比,OLV 30 min时Pa CO2和Ppeak值明显升高(q=5.657,P0.05;q=8.132,P0.05),Pa O2显著降低(q=14.375,P0.05)。术中8例使用1种以上的血管活性药物。4例在OLV刚开始时出现Sp O2下降,经右肺持续吹入低流量氧气2 L/min,左肺加用5 cm H2O PEEP处理后Sp O2升至97%以上。术后9例返回普通病房,3例转入ICU。术后均无复张性肺水肿、肺不张及其他麻醉并发症发生。结论胸、腹腔镜联合微创食管癌根治术对麻醉管理的要求较高,只有采取合理的麻醉管理措施,才能保证麻醉效果和手术安全。
[Abstract]:Objective to summarize the experience of anesthesia management in thoracic, laparoscopic and minimally invasive radical resection of esophageal cancer. Methods from May to November 2013, 12 cases of double lumen bronchial intubation combined with general anesthesia were performed with laparoscopy combined with minimally invasive radical resection of esophageal carcinoma. Anesthesia induction was induced by intravenous injection of propofol, fentanyl and atracurium cis-benzenesulfonate. Sevoflurane inhalation and continuous intravenous infusion of remifentanil were maintained during the operation. Left single lung ventilation (one-lung ventilation,OLV) was performed during thoracoscopic operation. The CO2 and Ppeak values of SBP,DBP,MAP,HR,Pa O 2 Pa before anesthesia induction, before OLV, 30 min after OLV and at the end of operation were recorded. Results Thoracic, laparoscopy combined with minimally invasive radical resection of esophageal carcinoma was performed in 12 cases. Operative time (425.7 卤90.1) min, anesthesia time (497.3 卤84.6) min. The total infusion fluid was (3020 卤606) ml, and the crystal fluid (2020 卤527) ml, colloid solution was (1000 卤316) ml,2. The amount of blood loss during the operation was (204 卤80) ml, and the urine volume was (700 卤231) ml.. Compared with that before anesthesia induction, there was a significant difference in SBP between before and after anesthesia induction (Q = 7.607, P 0.05, P = 4.890, P 0.05). There was significant difference in), MAP after anesthesia induction (QT 5.560 P 0.05), but there was no significant difference in DBP,HR at different time points (F2. 31P 0. 070 F0. 45 P0. 770). Compared with anesthetic induction, the Pa CO2 and Ppeak values of OLV 30 min were significantly higher than those after anesthesia induction (P 0.05, P 0.05), and), Pa O 2 significantly decreased (P 0.05, P < 0.05). During the operation, more than one vasoactive drug was used in 8 cases, and Sp O 2 decreased in 4 cases at the beginning of OLV. Sp O2 increased to more than 97% after continuous low flow oxygen 2 L / min in the right lung and 5 cm H 2O PEEP treatment in the left lung. 9 cases returned to general ward after operation, 3 cases were transferred to ICU. No retensible pulmonary edema, atelectasis and other anesthetic complications occurred after operation. Conclusion Thoracoscopy combined with minimally invasive radical resection of esophageal cancer requires a high level of anesthesia management. Only by taking reasonable anesthetic management measures can the anesthetic effect and operation safety be ensured.
【作者单位】：北京大学第三医院麻醉科;北京大学第三医院胸外科;
【分类号】：R614.2;R735.1

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