摘要
目的总结经口内镜下环形肌切开术(peroral endoscopic myotomy,POEM)及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗贲门失迟缓症及食管肿瘤的手术室外麻醉方法及术中并发症处理。方法对2008年12月-2013年3月在我院消化内镜中心82例行POEM及214例行食管ESD患者的术中麻醉记录整理并回顾分析,提取患者不同时点各项麻醉检测指标数值、术中严重并发症及治疗措施。结果 296例均行健忘镇痛慢诱导气管插管全麻,术中麻醉维持采用静脉输注丙泊酚并间断静注芬太尼,ESD手术时间平均(62.8±12.51)min,POEM手术时间平均(78.6±15.42)min,术毕均于内镜室内顺利拔管。32例(10.91%,32/296)于插管成功后单次注射丙泊酚时出现一过性血压降低,收缩压<80 mmHg(1 mmHg=0.133 kPa),8例(2.7%,8/296)术中收缩压下降幅度大于其基础值的20%,给予麻黄碱、去氧肾上腺素处理;两组患者术中1例(0.3%,1/296)发生支气管痉挛,3例(1%,3/296)气胸,12例(4%,12/296)皮下气肿,1例(0.3%,1/296)气腹,26例(8.78%,26/296)术中出现各类心律失常。结论健忘镇痛慢诱导气管插管全麻可为此类手术提供安全的手术条件及确切的麻醉效果,术中若出现严重气胸等手术并发症应及时明确诊断并果断处置。
Objective To summarize the experiences with general anesthesia of esophageal tumor patients undergoing peroral endoscopic myotomy （POEM） and endoscopic submucosal dissection （ESD） and the management of complications.Methods Clinical data about 82 patients who underwent POEM and 214 esophageal tumor patients who underwent ESD in our center from December 2008 to March 2013 were retrospective analyzed.Results General anesthesia of the 296 patients was induced by slow tracheal intubation amnesia analgesia.The anesthesia was maintained with combined intravenous propofol and intermittent intravenous fentanyl.The mean ESD and POEM time was 62.8 ± 12.51 min and 78.6 ± 15.42 min,respectively.After the anesthetic tube was removed,the transient systolic blood pressure was lower than 80 mmHg in 32 patients （10.91%）,the intra-operative systolic blood pressure decreased by 20% in 8 patients （2.7%）,bronchospasm occurred in 1 patient （0.3%）,pneumothorax developed in 3 patients （1%）,subcutaneous emphysema was observed in 12 patients （4%）,pneumoperitoneum was detected in 1 patient （0.3%）,arrhythmia was found in 26 patients （8.78%）.Conclusion The anesthetic efficiency of general anesthesia induced by slow tracheal intubation amnesia analgesia is good for operation.Complications such as pneumothorax should be promptly diagnosed and treated.
出处
《解放军医学院学报》
CAS
2014年第6期589-592,共4页
Academic Journal of Chinese PLA Medical School
关键词
麻醉和镇痛
插管法
气管内
内镜黏膜下剥离术
经口内镜下肌切开术
anesthesia and analgesia
intubation, intratrachea
endoscopic submucosal dissection
peroral endoscopic myotomy
