摘要
目的探讨电视胸腔镜手术(VATS)的麻醉处理和并发症的防治.方法VATS 639例,ASAⅠ～Ⅲ,男性401例,女性238例;平均年龄43岁,肺大疱自发性气胸328例,纵隔、食管、肺良、恶性肿瘤331例.静脉诱导双腔支气管插管,术中单肺通气,多功能监测仪监测循环、呼吸等功能.结果无麻醉手术死亡率,手术时间15～210 min,平均45 min,术中改开胸手术21例,围手术期并发症有复张性肺水肿8例,大出血5例,持续肺泡漏气16例,气胸复发3例,胸腔包裹性积液6例,双侧气胸并发循环骤停1例.结论VATS手术麻醉必须充分做好术前准备,应用合适的双腔支气管,术中健侧单肺通气提供良好的手术野,围术期加强监测及时诊治并发症,可提高VATS的安全性.
Objective:To discuss the anesthetic management and the prevent and treatment of the complications of video-assisted thoracoscopic surgery(VATS).Methods:Six hundred and thirty-nine patients underwent VATS were included.Among them,male401cases,female238cases,the mean age was43years,and ASAⅠ-Ⅲgrade.There were pulmonary bullae with or without spontaneous pneumothorax328cases,mediastinal,esophageal and pul-monary tumors331cases.After intravenous anesthetic induction,double lumen bronchial tubes(DLT)were inserted.Anesthesia was maintained by intravenous anesthetics and one-lung ventilation was used.Respiratory and circula-tory parameters were monitored by Agilent multifunction monitor.Results:The operative time was15~210min(mean45min).There were21cases converted to limited thoracotomy.There was no anesthetic or operative mortali-ty.The perioperative complications included reexpansion pulmonary edema8cases,massive bleeding5cases,con-tinuous alveolar leakage16cases,recurrent pneumothorax3cases,encysted thoracic effusion6cases and bilateral pneumothorax complicated with cardiac arrest1case.Conclusion:Adequate preoperative preparation is important for anesthesia for VATS.Proper DLT and one-lung ventilation during operation can afford adequate operaive field.Intensive monitoring at the perioperative period and prevent and treat the complications promptly can enhance the safety of anesthesia for VATS.
出处
《中国内镜杂志》
CSCD
2004年第8期18-19,22,共3页
China Journal of Endoscopy
关键词
电视胸腔镜
麻醉
双腔支气管
video-assisted thoracoscopy
anesthesia
double lumen endobronchial tube
