超高龄患者腹腔镜胆囊切除术围手术期麻醉处理  

Management of Superaged Patients Undergoing Laparoscopic Cholecystectomy(LC) During Perioperative Period

作　　者：张彩玲[1] 陈伟元[1] 

机构地区：[1]广东省梅州市人民医院麻醉三科,514089

出　　处：《中国实用医药》2012年第10期55-56,共2页China Practical Medicine

摘　　要：目的通过对超高龄患者(>75岁)腹腔镜胆囊切除术(LC)术前准备以及麻醉手术期间呼吸与循环生理功能变化的观察,选择适合该类患者最佳术前治疗方案和麻醉方法。方法 86例患者前均给予改良极化液治疗,均采用气管内复合全麻下行LC,观察气管插管、CO2气腹前、后、进腹探查分离时几个阶段的脉搏氧饱和度(SPO2)呼吸末二氧化碳分压(pet CO2)、血压、心电图、平均动脉压(MAP)等参数,并抽取气腹前、气腹后5 min、10 min、30 min桡动脉血行血气分析。结果 86例患者均平稳度过麻醉手术关,7例术后苏醒延迟,3例拔管后出现呼吸抑制,围手术期心律失常发生率37.1%,与气腹后DBP、Paw、Pa CO2、Pet CO2明显增高,气腹前有显著差异。结论高龄患者行LC术时呼吸循环功能变化更加剧烈,以吸入为主的静吸复合全麻身维持呼吸循环功能稳定和足够的通气量,患者苏醒快,术后恢复良好。同时术前保心、营养心肌、治疗呼吸系统疾病是减少并发症关键。强调预防和治疗术中高碳酸血症至关重要。Objective To investigate the changes of respiratory fuctions and treatment of superaged patients undergoing LC in pcrioperative period, in order to choose the optimum anesthetic ways. Methods Eighty-six over 75 years old patients, treated with GIK liquid preoperatively, were received general anesthesia with endotracheal incubation. SpO2, pet CO2, BP,ECG and MAP were recorded at intubating, before and after carbon dioxide pneumoperitoneum, and separating tissues respectively. Blood gas analysis was measured before pneumopeitoneum and 5 min, 10 min, 30 min after pneumoperitoneum respectively. Results 37.1% of the observed patients experienced arrhythmia. There were significant changes in the life signs after artificial pneumoeritoneum （ P 〈 0. 05 ）. Conclusion Combined Intravenous-inhalation general anesthesia can keep efficient tide-volume. It is of the utmost importance for the patient to prevent and treat hypercalSnia, respiratory and cardiac diseases before operation.

关 键 词：高龄 腹腔镜 复合麻醉 

分 类 号：R614[医药卫生—麻醉学]