经口内镜下肌切开术术中血压高心率快的原因浅析  

Analysis on influencing factors of increased blood pressure and heart rate in POEM

作　　者：刘胜群[1] 李站稳[1] 张景亮[1] 胡振华[1] 刘喆[1] 赵素贞[1] 陈传亮[1] 李轶[1] 

机构地区：[1]河南省人民医院暨郑州大学人民医院内镜中心,河南郑州450003

出　　处：《中国内镜杂志》2015年第10期1009-1012,共4页China Journal of Endoscopy

基　　金：河南省医学科技攻关计划项目(No:201403155)

摘　　要：目的探讨经口内镜下肌切开术（POEM）对患者血流动力学的影响。方法择期拟行POEM手术患者42例,年龄19~72岁,体重46~76 kg,ASA分级Ⅰ、Ⅱ级,根据术中是否应用降压药和（或）降心率药将42位患者分为S组27例（心率血压稳定组即未应用降压药和/或艾司洛尔）和NS组15例（心率血压不稳定组,应用降压药和/或艾司洛尔）。均采用静脉全身麻醉,常规麻醉诱导。记录患者T1（术前）、T2（诱导后）、T3（建隧道）、T4（止血关闭隧道）、T5（术毕）的平均血压（MBP）、心率（HR）、血氧饱和度（Sp O2）和呼气末二氧化碳分压（PETCO2）;记录血管活性药物使用情况;记录手术时间及用药时间、苏醒时间;记录麻醉药用量、液体量;记录并发症发生情况（恶心呕吐、肌阵挛、皮下气肿、纵膈气肿、气胸和阴囊气肿等）。结果 NS组血压于T3、T4和T5明显高于S组（P〈0.05）,NS组心率于T3和T4明显高于S组（P〈0.05）,NS组血压、心率于T3和T4明显高于术前T1（P〈0.05）,PETCO2于T3、T4和T5明显高于手术开始前T2（P〈0.05）。肾上腺素生理盐水用量：S组（160.00±56.00）ml,NS组（223.00±24.00）ml,P〈0.05。CO2异常积聚总发生率19%：S组7%,NS 40%,P〈0.05。结论术中二氧化碳CO2气体异常积聚和应用肾上腺素可能是POEM术中血压高心率快的原因。【Objective】 To investigate the hemodynamic change of patients who undergone peroral endoscopic myotomy.【Methods】 Forty-two patients were recruited（males and females） who were scheduled for peroral endoscopic myotomy（POEM）. Their age range was 19~72 years, weight 46~76 kg, and American Association of Anesthesiologist（ASA） classification ⅠorⅡ. The patients were divided into two groups： group S（the patients with stable circulation in operation） and group NS（those with ascending BP and HR in operation）. All patients had received intravenous general anesthesia, during which POEM, MBP, HR, Sp O2 and PETCO2were recorded at T1（pre-operation）, T2（after introduction）, T3（open tunnel）, T4（hemostasis, shut tunnel）, and T5（end）, respectively. Furthermore, the operating time, time of using anaesthetics, reviving time, dosage of drugs and volume of liquid were also recorded. The complications（nausea, vomiting, myoclonus, pneumoderm subcutaneous emphysema, mediastinal emphysema, pneumothorax, and scrotal emphysema） were documented for statistical purpose. 【Results】The BP of patients in group NS was significantly higher than that in group S at T3, T4 and T5（P〈0.05）, and the HR of patients in group NS was higher than that in group S at T3 and T4（P〈0.05）. In group NS, BP and HR at T3 and T4were higher than those at T1（P〈0.05）; PETCO2 at T3, T4 and T5was higher than that at T2（P〈0.05）. Moreover, the volume of mixture of a-drenaline and normal saline was（160.00 ± 56.00）ml in group S and（223.00 ± 24.00）ml in group NS, respectively（P〈0.05）. Finally, the total incidence rate of abnormal gather of gas was 19 %（7 % in group S and 40 % in group NS, P〈0.05）.【Conclusions】The potential cause of increased BP and HR in POEM was the abnormal accumulation of gas and using of adrenaline.

关 键 词：贲门失弛缓症 经口内镜肌切开术 高血压 心率 肾上腺素 

分 类 号：R573.7[医药卫生—消化系统]