慢性胃炎老年患者喉罩全身麻醉下返流误吸一例  

Aspiration for an Elderly Patient With Chronic Gastritis Undergoing Cholecystectomy Under Laryngeal Mask General Anesthesia: A Case Report

作　　者：周安能 唐海斌 

机构地区：[1]重庆市万盛经济技术开发区人民医院麻醉科,重庆400800 [2]西南医科大学附属中医医院麻醉科,四川泸州646000

出　　处：《中国继续医学教育》2018年第26期89-90,共2页China Continuing Medical Education

基　　金：重庆市卫生和计划生育委员会医学科研项目(2016MSXM209)

摘　　要：目的通过报道一例术前合并慢性胃炎的老年女性患者发生返流误吸的病例及其临床处理、转归,分析其发生返流误吸的可能原因,总结经验,为临床提供参考。方法回顾性分析了本院一例在喉罩全身麻醉下行开腹胆囊切除术发生返流误吸的病例。通过查阅文献重点讨论了该患者发生返流误吸的可能原因、发生返流误吸后的处理方法及慢性胃炎患者全麻期间发生返流误吸的预防措施。结果通过手术期间气管插管及支气管内反复灌洗等一系列处理以及在ICU呼吸机支持、抗感染、纠正内环境紊乱等治疗,13天后患者完全康复出院。结论慢性胃炎患者可能存在胃排空延迟,胃内残留液体增加,虽经严格禁食,术前仍可能呈"饱胃"状态,增加全麻过程中返流误吸的风险,术前应充分评估返流误吸风险并慎重选择喉罩全麻。Objective Report a case of the regurgitation and aspiration of an elderly female patient with chronic gastritis, and analyze the possible causes of the regurgitation and aspiration, to summarize the experience and provide reference for clinical practice. Methods A case of aspiration for cholecystectomy under laryngeal mask general anesthesia was analyzed retrospectively. The possible causes of the aspiration, treatment after the aspiration and preventive measures for the aspiration during general anesthesia in patients with chronic gastritis were discussed through the literature review. Results A series of treatments, such as tracheal intubation and repeated bronchoalveolar lavage during the operation; as well as during the ICU the mechanical ventilation, anti infection, and disturbance of the internal environment were treated. After 13 days, the patients recovered completely and discharged from the hospital. Conclusion The patients with chronic gastritis may have delayed gastric emptying and increased residual fuid in the stomach. Though strict fasting, it may still be “full stomach” before operation, and increase the risk of the regurgitation and aspiration during the process of general anesthesia. The risk of the regurgitation and aspiration should be fully evaluated before operation and the laryngeal mask general anesthesia should be carefully selected.

关 键 词：慢性胃炎 老年患者 喉罩 全身麻醉 返流 误吸 

分 类 号：R614[医药卫生—麻醉学]