胃食管反流病患者手术治疗中的麻醉应对措施  

Anesthesia Countermeasure in Patients with Gastroesophageal Reflux Disease

作　　者：隋波[1] 田雷[1] 马玉恒[1] 李冠华[1] 陈秀[2] 吴继敏[2] 汪忠镐[2] 

机构地区：[1]第二炮兵总医院麻醉科,北京100088 [2]第二炮兵总医院胃食管反流中心,北京100088

出　　处：《临床误诊误治》2010年第4期321-323,共3页Clinical Misdiagnosis & Mistherapy

基　　金：国家高技术研究发展计划(863计划)资助项目(2007AA02Z4Z6)

摘　　要：目的探讨胃食管反流病患者在静脉麻醉下行经食管射频治疗和在全麻下行腹腔镜胃底折叠术中"哮喘"发作的应对措施。方法选择胃食管反流病36例,其中8例在静脉麻醉下行经食管射频治疗术(射频治疗组),28例在全麻下腹腔镜胃底折叠术(腹腔镜手术组),对治疗中"哮喘"发作期间的临床资料进行总结分析。结果射频治疗组及腹腔镜手术组术中均出现不同程度的"哮喘",处理措施包括静脉注射糖皮质激素和氨茶碱,腹腔镜手术组同时吸入七氟烷并予呼吸机正压通气。射频治疗组7例、腹腔镜手术组25例经上述处理后"哮喘"不同程度的缓解;余4例加用肾上腺素后"哮喘"缓解。结论胃食管反流病患者术中"哮喘"症状易发作,是麻醉的危险因素之一,麻醉医师应高度重视并妥善处理。症状易发作,是麻醉的危险因素之一,麻醉医师应高度重视并妥善处理。Objective To explore the anesthesia countermeasure of asthma attack in the Stretta radiofrequency treatment under endoscope and laparoscopic Nissen fundoplication（LNF） for patients with gastroesophageal reflux disease（GERD）.Methods 36 patients with GERD were selected to be treated by the Stretta radiofrequency under endoscope with intravenous anesthesia（n=8） and by LNF with general anesthesia（n=28）.Anesthesia measures during asthma attack were evaluated and analyzed.Results 8 patients of the Stretta radiofrequency treatment under endoscope and 28 patients of LNF suffered from asthma attack.The countermeasures were intravenous glucocorticoid and aminophylline,sevoflurane inhalation,the mechanical ventilation with high positive end-expiratory pressure（PEEP）.After treatment,7 out of 8 patients and 25 out of 28 patients showed remission.The other 4 patients with severe asthma attack also showed remission after being given epinephrine.Conclusion Patients with GERD are subject to asthma attack,which is one of the risk factors in applying anesthesia,so anesthesiologists should be very careful in dealing with it.

关 键 词：胃食管反流病 哮喘 麻醉 胃底折叠手术 射频治疗 

分 类 号：R614.2[医药卫生—麻醉学]