胃食管反流胃底折叠术中支气管痉挛的处理  

Management of bronchospasm attack taken place in fundoplication of gastroesophageal reflux disease

作　　者：隋波[1] 苏冬梅[1] 马玉恒[1] 田雷[1] 孙潮涌[1] 吴继敏 陈秀 汪忠镐 

机构地区：[1]第二炮兵总医院麻醉科,北京市100088 [2]胃食管反流病治疗中心

出　　处：《临床麻醉学杂志》2010年第3期221-223,共3页Journal of Clinical Anesthesiology

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(GERD)胃底折叠术中支气管痉挛的发生与处理措施。方法总结GERD胃底折叠术中发生支气管痉挛的34例资料。结果 34例中剖腹手术6例,腹腔镜手术28例。支气管痉挛有8例在气管插管后即刻发生,10例在气管插管后1～10min手术开始前发生,14例在术中不同时间不明原因发生,1例在术后气管拔管送回监护病房后发生,1例气管插管后的顽固支气管痉挛未行手术。处理措施均为静注糖皮质激素和氨茶碱,吸入七氟醚,呼吸机正压通气。以上措施无效者加用肾上腺素。结论 GERD胃底折叠术患者多有支气管痉挛的呼吸道症状,为麻醉的危险因素之一,麻醉医师应高度重视,妥善处理。Objective To explore the countermeasure of bronchospasm attack in 34 cases undergoing fundoplication of gastroesophageal reflux disease（GERD）.Methods Data of 34 cases with bronchospasm attack undergoing fundoplication of GERD were reviewed retrospectively.Results Of 34 cases,bronchospasm attack took place in 6 cases of laparotomic fundoplication and 28 cases of laparoscopic fundoplication.Bronchospasm happened immediately after intubation in 8 cases,within 1 to 10 min after intubation in 10 cases,during the operation in 14 cases,on the way to ICU after extubation in 1 case. 1 cases of severe bronchospasm attack could not be controlled after intubation and could not be operation. All cases were treated with intravenous glucocorticoids and aminophylline,sevoflurane inhalation,mechanical ventilation with high positive end-expiratory pressure（PEEP）.The patient of severe bronchospasm attack could not be controlled add using epinephrine.Conclusion Most patients with GERD menefested bronchospasm,which is one of the risk factors for anesthesia,and should be paid attention to.

关 键 词：胃食管反流病 支气管痉挛 

分 类 号：R571[医药卫生—消化系统]