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[摘 要 ] 目的 总结腹腔镜直肠癌手术麻醉管理的经验. 方法 回顾性分析本院2010年2月～2012年2月共40例腹腔镜下直肠癌根治手术的患者麻醉资料,其中28例（57.5%）合并一种或两种全身性疾病,ASAⅠ～Ⅱ级.所有患者均采用气管内插管全身麻醉,术中监测无创血压（BP）、平均动脉压（MAP）、心率（HR）、心电图（ECG）、脉搏血氧饱和度 （SpO2）、呼气末CO2分压 （PETCO2）. 结果 气腹后10 min MAP、HR、PETCO2较气腹前明显升高,经处理,气腹后30 min MAP、HR明显降低,PETCO2无明显升高.患者均在手术间拔除气管导管,停止麻醉至拔除气管导管时间5～40 min. 结论 对于腹腔镜直肠癌患者手术的麻醉管理来说,详细的术前访视和全面评估患者,完善围术期监测,加强术中管理,及时纠正处理合并症都是安全的前提和保障.
[关 键 词 ] 直肠癌；腹腔镜；麻醉；管理
[中图分类号] R614 [文献标识码] A [文章编号] 1674-4721（2012）07（a）-0108-02
Anesthesia management during laparoscopic colorectal surgery
JIANG Yunhui
Department of Anesthesiology, Shunyi Hospital, Beijing 101300, China
[Abstract] Objective To summarize experience in anesthesia management for patients undergoing laparoscopic colorectal surgery. Methods The perioperative data of 40 patients with colorectal carcinoma who underwent laparoscopic surgery in our hospital from February 2010 to February 2012 were analyzed retrospectively. Twenty eight cases (57.5%) of the patients had one or two conitant systemic diseases, ASAⅠ-Ⅱ. All the patients received general anesthesia with trachealint ubation. Continuous blood pressure(BP), the mean arterial pressure (MAP), heart rate(HR), electrocardiogram(ECG), saturation of pulse oxygen(SpO2), and end-tidal carbondioxide pressure(PETCO2) were monitored during the surgery. Results The mean arterial pressure(MAP), heart rate(HR) and PETCO2 of the patients significantly increased at 10 min after pneumope ritoneum, after adjusting ventilation and giving drugs, MAP and HR decreased significantly, but PETCO2 didn't change. Extubation was carried out in operating room, the erage extubation time was 5-40 min. Conclusion For the anesthetic management of patients with laparoscopic rectal cancer surgery, a detailed preoperative visit and prehensive assesent of patients, and improving perioperative monitoring, and strengthening the intraoperative management of timely corrective treatment plications are the premise and guarantee of safety.
[Key words] Colorectal cancer, Laparoscopy, Anesthesia, Management
腹腔镜直肠癌手术是一种新型的微创技术,目前已在国内外广泛开展,该手术的优点得到广泛认可,如对患者创伤小、术后恢复快、住院时间短等[1],但是由于气腹的时间较长,可能引起生命体征的剧烈变化,增加了手术风险,因此对手术麻醉管理提出了更高的要求.现将本院2010年2月～2012年2月40例腹腔镜直肠癌根治手术患者的麻醉管理经验报道如下：
1.资料与方法
1.1 一般资料
本组40例直肠癌患者,年龄（55.3±5.7）岁,体重（57±7.7） kg.其中28例（57.5%）合并一种或两种的全身性疾病,包括高血压、冠心病、糖尿病、脑血管疾病、肺部疾病、心律失常等.术前积极纠正贫血和低蛋白血症,血红蛋白（Hb）维持在90 g/L左右,清蛋白（ALB）维持在30 g/L左右,血压控制在160/90 mm Hg,血糖控制在8 mol/L以下,ASAⅠ～Ⅱ级,术前检查无重要脏器功能障碍.