经皮内窥镜引导下胃造口术的麻醉  

Anesthetic Management during Percutaneous Endoscopic Gastrostomy

作　　者：徐建青[1] 黄宇光[1] 罗爱伦[1] 马志强[2] 康维明[2] 于健春[2] 

机构地区：[1]中国医学科学院 北京协和医学院 北京协和医院麻醉科,北京100730 [2]中国医学科学院 北京协和医学院 北京协和医院基本外科,北京100730

出　　处：《协和医学杂志》2012年第4期452-456,共5页Medical Journal of Peking Union Medical College Hospital

摘　　要：目的探讨经皮内窥镜引导下胃造口术(percutaneous endoscopic gastrostomy,PEG)的临床麻醉经验。方法回顾性分析北京协和医院90例PEG患者的临床资料,并对麻醉方式、静脉麻醉药物和麻醉风险进行总结。结果 85例采用表面麻醉+局部麻醉+静脉镇静或全麻,其中仅1例采用气管插管全麻;其他5例采用表面麻醉+局部麻醉。静脉麻醉药物主要为咪达唑仑、芬太尼或舒芬太尼、丙泊酚或依托咪酯,用药剂量和方法各不相同。在PEG过程中患者血流动力学和呼吸基本平稳,但可能发生低氧血症、高血压和心动过缓等风险。与PEG前比较,PEG期间收缩压、舒张压和心率最小值明显下降,脉搏血氧饱和度最大值明显上升,差异有统计学意义(P<0.05)。结论 PEG的麻醉方式可以采用表面麻醉+局部麻醉+静脉镇静或全麻,但应加强麻醉管理。Objective To summarize the clinical experience in anesthetic management during percutaneous endoscopic gastrostomy （PEG）. Methods The clinical data of 90 patients with PEG in our hospital were analyzed retrospectively. Their anesthetic methods, intravenous anesthetic drugs, and anesthetic risks were summarized. Results A total of 85 patients underwent topical anesthesia ＋ local anesthesia ＋ intravenous sedation or general anesthesia, among whom only one patient was treated with endotracheal intubation under general anesthesia while five patients with topical anesthesia ＋ local anesthesia. The main intravenous anesthetic drugs included midazolam, fentanyl （or sufentanil） , and propofol （or etomidate） , with different medication dosages. The hemodynamie and respiratory changes were basically stable during PEG, while adverse events such as hypoxemia, hypertention, and bradycardia occurred occasionally. The minimal systolic and diastolic blood pressures and heart rate decreased significantly and the maximal oxygen saturation by pulse oximetry increased significantly during PEG compared with those before PEG （ all P 〈 0.05 ）. Conclusion PEG can be carried out under topical anesthesia ＋ local anesthesia ＋ intravenous sedation or general anesthesia; nevertheless, anesthetic management should be emphasized.

关 键 词：经皮内窥镜引导下胃造口术 麻醉 

分 类 号：R614[医药卫生—麻醉学]