弥漫性肺疾病病人局麻下开胸肺活检的麻醉性监护  

Local Infiltration and Monitored Anesthesia Care Used for Lung Biopsy

作　　者：赵素真[1] 秦秉玉[1] 张加强[1] 陈莎莉[2] 钱如林[3] 

机构地区：[1]河南省人民医院麻醉科,郑州 450003 [2]河南省人民医院手术室,郑州 450003 [3]河南省人民医院胸外科科,郑州 450003

出　　处：《麻醉与监护论坛》2007年第4期225-226,共2页Forum of Anesthesia and Monitoring

摘　　要：目的：探讨对弥漫性肺疾病病人局麻下行小切口开胸肺活检实施麻醉性监护技术的可行性。 方法：疑似双侧弥漫性实质性肺疾病拟在局麻下行小切口开胸肺活检患者30例，男21例，女9例，年龄16-72岁，均不用术前药，连续监测收缩压（SBP）、舒张压（DBP）、心电图（ECG）、脉搏血氧饱和度（SpO2），呼吸频率（RR），并观察呼吸幅度，同时面罩吸氧，氧流量2L/min。1%利多卡因局麻，切口长约5-7cm，根据病人情况，局麻前缓慢静滴咪达唑仑1-3mg，芬太尼0.05-0.1mg。开胸前对相应肋间隙行肋间神经阻滞，必要时追加芬太尼0.05-0.1mg。记录患者入室平卧5min（基础值）、切皮后即刻、打开胸腔后即刻、取肺活组织块时及手术结束时的SBP、DBP、HR、SpO2及RR。 结果：切皮后即刻、开胸后即刻、取活检时及手术完毕时的SBP、DBP、HR及SpO2与术前基础值比较均无统计学意义（P〉0.05或0.01）。 结论：对弥漫性肺疾病病人局麻下行小切口开胸肺活检实施麻醉性监护可保证手术顺利进行，对循环系统干扰小，术后恢复迅速。Objective： To evaluate the feasibility of local infiltration and monitored anesthesia care used for lung biopsy. Methods： Thirty patients （21 males,9 females） aged between 16-72yrs undergoing elective surgery were studied. The patients were unpremedicated. Supplemental oxygen, 2 L/min, was administered via a facemask. All patients received midazolam 1-3mg and fentanyl 0.05-0.1mg before infiltrating the operative field with local anesthetic （1% lidocaine）. Systolic blood pressure （SBP）, diastolic arterial blood pressure （DBP）, pulse oxygen saturation （SpO2） and respiratory rate （RR） were recorded before induction of anesthesia, skin incision, chest opened, chest exploration, and immediately after operation, respectively. Results： SBP, DBP, SpO2 and HR didn＇t show significantly changes after skin incision, chest opened, chest exploration, and immediately after operation. But the RR were significantly increased during chest opening, chest exploration, and immediately after operation （P〈0.05 or 0.01）. Conclusion： Local infiltration combined with monitored anesthesia care can be safely used for lung biopsy.

关 键 词：麻醉性监护 局部麻醉 肺活检 

分 类 号：R563.04[医药卫生—呼吸系统]