侧卧折刀状体位下腹腔镜手术患者胃食管反流的发生情况：与仰卧头高/头低位比较  

Development of gastro-esophageal reflux during laparoscopic surgery in lateral jack-knife position： a comparison with reverse Trendelenburg/Trendelenburg position in patients lying supine

作　　者：刘颖[1] 卢悦淳[1] 刘玲[1] 孙健[1] 吕国义[1] 

机构地区：[1]天津医科大学第二医院麻醉科,300211

出　　处：《中华麻醉学杂志》2014年第10期1174-1177,共4页Chinese Journal of Anesthesiology

基　　金：天津市卫生局科技基金项目（2012KZ082）

摘　　要：目的 通过与仰卧头高/头低位比较,评价侧卧折刀状体位下腹腔镜手术患者胃食管反流的发生情况.方法 择期行腹腔镜手术患者90例,年龄18～64岁,性别不限,ASA分级Ⅰ级或Ⅱ级,BMI 18～30 kg/m2,采用随机数字表法,将其分为3组（n=30）,侧卧折刀状体位组（L组）、仰卧头低位组（T组）和仰卧头高位组（Tre组）.采用咪达唑仑-舒芬太尼-异丙酚-顺苯磺酸阿曲库铵进行麻醉诱导,靶控输注异丙酚及瑞芬太尼维持麻醉.术中食管下段pH值≤4且持续时间≥1 min时为发生胃食管反流.记录术中胃食管反流发生情况以及胃食管反流时食管下段pH最低值.结果 与Tre组比较,L组胃食管反流发生率（27％）、发生总次数升高（P＜0.05）,L组和T组上述指标比较差异无统计学意义（P＞0.05）.L组、T组和Tre组胃食管反流时食管下段pH最低值分别为2.1±1.3、2.6±1.2和3.5.结论 侧卧折刀状体位下腹腔镜手术患者胃食管反流发生率为27％,胃食管反流发生几率高于仰卧头高位.Objective To evaluate development of gastro-esophageal reflux （GER） during laparoscopic surgery in lateral jack-knife position under general anesthesia through comparing with reverse Trendelenburg/ Trendelenburg position in the patients lying supine. Methods Ninety patients of both sexes, aged 18-64 yr, of ASA physical status Ⅰ or Ⅱ , with body mass index of 18-30 kg/m2 , scheduled for elective laparoscopic surgery under general anesthesia, were randomly divided into 3 groups （ n = 30 each） ： lateral jack-knife position group （group L）, Trendelenburg position group （group T） and reverse Trendelenburg position group （group Tre）. Anesthesia was induced with midazolam, sufentanil, propofol and cisatracurium besylate and maintained with propofol and remifentanil given by target-controlled infusion. A pH-sensitive probe was inserted through nose into the lower esophagus and pH value was continuously recorded until 1 min after extubation. GER was defined as pH value ≤ 4 lasting for ≥ 1 min in the lower esophagus during surgery. The development of GER during surgery and the lowest pH value in the lower esophagus when GER developed were recorded. Results Compared with group ＂Tre, the incidence of GER （27 % ） and total number of times GER had occurred were significantly increased in group L, and no significant changes were found in the indices mentioned above in L and T groups. When GER developed, the lowest pH value in the lower esophagus was 2.1 ± 1.3, 2.6± 1.2 and 3.5 in L, T and Tre groups, respectively. Conclusion The incidence of GER is 27 % during laparoscopic surgery when the patients are in lateral jack-knife position and it is higher than that obtained with reverse Trendelenburg position in the patients lying supine.

关 键 词：体位 腹腔镜检查 胃食管反流 

分 类 号：R655[医药卫生—外科学]