胸、腹腔镜联合微创食管癌根治术的麻醉管理  

Anesthetic Management of Combined Thoracoscopic and Laparoscopic Esophagectomy

作　　者：徐德军[1] 马少华[2] 王军[1] 吴长毅[1] 

机构地区：[1]北京大学第三医院麻醉科,北京100191 [2]北京大学第三医院胸外科,北京100191

出　　处：《中国微创外科杂志》2015年第4期293-297,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的总结胸、腹腔镜联合微创食管癌根治术的麻醉管理经验。方法 2013年5~11月12例双腔支气管内插管静吸复合全麻下行胸、腹腔镜联合微创食管癌根治术。麻醉诱导采用丙泊酚、芬太尼和顺苯磺酸阿曲库铵静脉注射,插入左侧双腔支气管导管,纤维支气管镜检查定位。术中吸入七氟烷和静脉持续输注瑞芬太尼维持麻醉。胸腔镜操作中行左侧单肺通气（one-lung ventilation,OLV）。记录麻醉诱导前、麻醉诱导后、OLV前、OLV后30 min以及手术结束时等不同时点SBP、DBP、MAP、HR、Pa O2、Pa CO2和Ppeak值。结果 12例均完成胸、腹腔镜联合微创食管癌根治术。手术时间（425.7±90.1）min,麻醉时间（497.3±84.6）min。术中共输液（3020±606）ml,其中晶体液（2020±527）ml,胶体液（1000±316）ml,2例各输入红细胞悬液400 ml;术中出血量（204±80）ml,尿量（700±231）ml。与麻醉诱导前相比,SBP在麻醉诱导后、OLV前和手术结束时有统计学差异（q=7.607,P〈0.05;q=4.890,P〈0.05;q=3.713,P〈0.05）,MAP在麻醉诱导后有统计学差异（q=5.560,P〈0.05）;不同时点DBP、HR均无显著性差异（F=2.31,P=0.070;F=0.45,P=0.770）。与麻醉诱导后相比,OLV 30 min时Pa CO2和Ppeak值明显升高（q=5.657,P〈0.05;q=8.132,P〈0.05）,Pa O2显著降低（q=14.375,P〈0.05）。术中8例使用1种以上的血管活性药物。4例在OLV刚开始时出现Sp O2下降,经右肺持续吹入低流量氧气2 L/min,左肺加用5 cm H2O PEEP处理后Sp O2升至97%以上。术后9例返回普通病房,3例转入ICU。术后均无复张性肺水肿、肺不张及其他麻醉并发症发生。结论胸、腹腔镜联合微创食管癌根治术对麻醉管理的要求较高,只有采取合理的麻醉管理措施,才能保证麻醉效果和手术安全。Objective To summarize the anesthetic management of combined thoracoscopic and laparoscopic minimally invasive esophagectomy.Methods Twelve patients underwent combined thoracoscopic and laparoscopic esophagectomy under intravenous and inhalational anesthesia.After induction of anesthesia with propofol,fentanyl,and cisatracurium,a double-lumen endobronchial tube was intubated and its position was checked by using fiberoptic bronchoscopy.Anesthesia was maintained with sevoflurane and remifentanil.One-lung ventilation（OLV） was performed during the thoracoscopic operation.Values of systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）,heart rate（HR）,arterial partial pressure of oxygen（Pa O2）,arterial partial pressure of carbon dioxide（Pa CO2）,and peak airway pressure（Ppeak） were recorded at following time points：before anesthesia induction,after anesthesia induction,before OLV,30 min after OLV,and end of surgery.Results The operation was successfully completed in all the patients.The total operation time was（425.7 ± 90.1） min and the anesthesia time was（497.3 ± 84.6） min.The volume of fluid given intraoperatively was（3020 ± 606） ml,including crystal solution（2020 ± 527） ml and colloid solution（1000 ± 316） ml.Two patients received 400 ml red blood cells.The volume of blood loss and urinary output intraoperatively were（204 ± 80） ml and（700 ± 231） ml,respectively.The SBP values after anesthesia induction,before OLV,and at the end of surgery were significantly lower than that before anesthesia induction（q = 7.607,P 0.05; q = 4.890,P 0.05; q = 3.713,P 0.05）; the MAP after anesthesia induction was significantly lower than that before anesthesia induction（q =5.560,P 0.05）.No significant difference was found between values of DBP and HR（F = 2.31,P = 0.070; F = 0.45,P = 0.770）.The Pa CO2 and Ppeak values at 30 min after OLV were significantly higher than those after anesthesia induction（q = 5.657,P 0.05;q = 8.13

关 键 词：胸腔镜 腹腔镜 麻醉 食管癌根治术 

分 类 号：R614.2[医药卫生—麻醉学]