摘要
目的探讨影响电视胸腔镜、腹腔镜联合下食管癌根治术麻醉处理安全性的相关因素。方法 30例食管癌根治术患者采用静脉复合全身麻醉,借助纤维支气管镜,对置入F35～39 Robertshow双腔支气管导管进行定位,胸腔镜手术期间行单肺通气,腹腔镜气腹期间改双肺通气。结果 30例手术及麻醉效果满意,血液动力学维持平稳,手术平均时间(243±42)min,其中单肺通气平均时间(102±19)min。术中肺萎陷不佳或SpO2持续<95%时,及时通过纤支镜调整导管位置,清除气道分泌物,以保持呼吸道通畅。术中呼气末二氧化碳均在正常范围。结论合理选择麻醉用药,双腔管定位准确,术中采用适宜的呼吸管理模式、术者与麻醉医生密切配合,是胸、腹腔镜联合手术麻醉管理成功的关键。
Objective To analyse some major problems of anesthetic inanagement in patients undergoing video - assisted thoraco-scopic and laparoscopic esophagectomy for radical operation of esophageal cancer. Methods Thirty patients under total intravenous general anesthesia, with the aid of fiberoptic bronchoscope, were placed F35 -39 Robertshow tube （a double -lumen endobronchial tube, DLT）. One - lung ventilation （OLV） was performed during thoracoseopic surgery. Two - lung ventilation was administered in laparoscopic pneumo-peritoneum. Results All operations were performed successfully. The induction and maintaining of anesthesia were satisfactory. To facilitate thoracoscopic procedure, DLT was accurately positioned by fiberoptic bronehoscope. The hemodynanlics parameters remained stable in the period of operation. The surgical procedures lasted for（243 ±42）rain, and the time of OLV was （ 102 ± 19） rain. The level of PETCO2 was maintained normally during thoracoscopic and laparoscopic esophagectomy. Conclusion Some factors, such as reasonable anesthetic drugs, correct position of DLT, close coordination between anesthetist and surgeon, and strengthened ventilation management, are the keys for a successful esophagectomy by video -assisted thoracoscope and laparoscope in patients with esophageal cancer.
出处
《安徽医学》
2013年第12期1792-1794,共3页
Anhui Medical Journal
关键词
胸腔镜
腹腔镜
食管癌
根治术
麻醉
Thoracoscope
Laparoscope
Esophageal carcinoma
Radical operation
Anesthesia
