摘要
目的 探讨高龄患者行内镜引导下经皮胃造瘘术的麻醉方法和术中管理.方法 回顾性分析解放军总医院2012年6月至2013年5月80岁以上高龄患者,接受内镜引导下经皮胃造瘘手术的麻醉管理并复习相关文献.结果 5例患者中,局麻复合基础麻醉（OAAS评分4分）用于合并气管食管瘘的患者,余4例均采用局麻复合静脉镇痛/深镇静麻醉（OAAS评分1～2分）,予异丙酚或依托咪酯等维持,保留患者自主呼吸,维持SpO2＞95%;麻醉诱导期,1例患者发生短暂呼吸抑制,2例血压下降心率减慢,操作过程中出现血压高心率快1例,需对症处理,1例轻微呛咳,所有患者麻醉过程均平稳,无气道梗阻,支气管痉挛和误吸.其中4例患者置入空肠营养管,平均手术时间80 min（40～150 min）.术毕意识恢复至术前水平,生命体征平稳,术后未发现心肺及麻醉相关并发症.结论 局麻复合静脉镇痛/镇静的麻醉方法对内镜引导下经皮胃造瘘手术的高龄患者是安全有效的;术前正确评估患者心肺功能和主观配合度,术中气道管理和循环监控是麻醉医生关注的重点.
Objective To evaluate anesthestic techniques for elderly patients during percutaneous endoscopic gastrostomy （PEG）. Methods Clinical data about 5 cases aged 80 years or more undergoing PEG from June 2012 to May 2013 in Chinese People＇s Liberation Army General Hospital were retrospectively analyzed and literature review. Results Analgesia/minimal sedation combined with local anesthesia （ LA including throat spray and operative site infiltrated ） is employed in the one of patients with Tracheoesophageal Fistula （TEF） , for the remaining patients, analgesia/deep sedation and LA combination were used, during induction, temporary respiratory depression, blood pressure and heart rate decreased occurred respectively in the different patient, assisted ventilation and ephedrine IV was effective, the anesthesia strategy was to maintain a desired sedation with propofol or etomidate intravenously in small increments or by adjusted infusion , and to keep SpO2 at 95% or more with a supplemental oxygen through facemask under spontaneous ventilation. During the therapeutic period, an increase in blood pressure （BP） and heart rate （HR）, slight cough occurred in one patient. Of all cases undergoing this procedure uneventfully and recovering well at the end of surgery without aspiration, asthma or airway obstruction, 4 were placed with jejunal feeding tube successfully, the mean duration of surgery is 80 rain, ranging between 40 and 150 min, no anesthesia-related or cardiorespiratory complications occurred at follow-up. Conclusions a combination of intravenous sedative/analgesic anesthesia with LA is efficiently and safely suited to the patients at advanced age during PEG, for anesthesiologists, it should be the most important tenets of anesthetic practice to have preanesthestic evaluation well done about cardiorespiratory function and the ability of individual cooperation with anesthesia providers, to control airway and to manage circulatory system intraoperatively.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第45期3629-3631,共3页
National Medical Journal of China
关键词
老年
经皮内镜引导下胃造瘘术
麻醉
管理
Elderly
Percutaneous endoscopic gastrostomy
Anesthesia
Management
