胸腔镜下胸交感神经干切断术治疗手汗症250例的麻醉体会  

Retrospective review of 250 cases of anesthesia for thoracoscopic sympathectomy for palmar hyperhidrosis

作　　者：赵建英[1] 林健清[1] 林财珠[1] 林群[1] 

机构地区：[1]福建医科大学附属第一医院麻醉科,福建福州350005

出　　处：《中国内镜杂志》2007年第7期697-699,共3页China Journal of Endoscopy

摘　　要：目的回顾性观察电视胸腔镜行双侧T2～T4交感神经干切断术治疗手汗症的麻醉方法,术中、术后不良反应的发生及其处理效果。方法250例手汗症患者在双腔支气管内麻醉下经电视胸腔镜行双侧T2～T4交感神经干切断术。根据吸入麻醉药的不同分为异氟醚吸入麻醉组(157例)和七氟醚吸入麻醉组(93例),分别吸入异氟醚-笑气或七氟醚-笑气,万可松维持麻醉。术中行单肺通气,术毕不放置胸腔引流。观察术中单肺通气效果、手术后苏醒时间、呼吸抑制及疼痛情况。结果七氟醚吸入麻醉组手术结束至病人清醒时间为(8.31±3.77)min,明显短于异氟醚吸入麻醉组(15.16±9.52)min(P<0.01),异氟醚吸入麻醉组有6例麻醉苏醒后出现胸闷、气短、脉搏氧饱和度轻度下降等短暂的呼吸不顺症状。术中单肺通气效果满意,翻转体位时,双腔气管导管出现移位27例,其中左支气管插管11例,右支气管插管16例,均在纤维支气管镜明视下调整入位。手术第1天需使用镇痛药病人71例,发生率为29.2%,第2天疼痛均能够缓解,未使用镇痛药。结论七氟醚吸入麻醉较异氟醚更适合用于电视胸腔镜下行双侧T2～T4交感神经干切断手术。纤维支气管镜在支气管插管中的定位具有明显的优势。[Objective] To retrospectively analyze the anesthesia, perioperative complications and their handling results in bilateral T2-T4 sympathectorny through a thoracoscope for palmar hyperhidrosis. [Methods] 250 patients with hyperhidrosis under general anesthesia with double-lumen endotracheal tube for thoracoscopic sympathectomy were retrospectively devided into two groups： Group isoflurane and Group sevoflurane. One-lung ventilation anesthesia was maintained with isoflurane-N2O-Vecuronium or sevoflurane-N2O-Vecuronium respectively. Chest tubes were not required after the surgery. Their One-lung ventilations, postoperative waking up time, respiratory depression and postoperative pain conditions were observed. [Results] The duration of Group sevoflurane awaked from the end of surgery （8.31±3.77） rnin was obviously shorter than Group isoflurane＇s （15.16±9.52） min （P 〈0.01）. There occurred 6 patients with transient respiratory depression after anesthesia in Group isoflurane. One-lung ventilation was satisfied, there 27 cases happened double-lumen endotracheal tubes dislodged, among which there occurred 11 in the left-sided double-lumen tubes and 16 in the fight-sided. The double-lumen tubes malpositioned were all adjusted by bronchofibroscopy. 71 patients needed analgesic in the first day of surgery with incidence rate of 29.2%, and all alleviated in the second day and needed no analgesic. [Conclusions] Sevoflurane anesthesia was more suitable for thoracoscopic sympathectomy than isoflurane. Bronchofibroscope has obvious superiority for positioning the doublelumen endotracheal tubes.

关 键 词：手汗症 胸交感神经干切断术 胸腔镜 麻醉 

分 类 号：R655[医药卫生—外科学]