南方医科大学学报

南方医科大学学报 ›› 2017, Vol. 37 ›› Issue (05): 712-.

• • 上一篇    

53 例机器人食管癌颈胸腹三切口手术麻醉管理

刘晓清，张天华，程静，李慧婷，操隆辉，谭子辉，林文前   

  • 出版日期:2017-05-20 发布日期:2017-05-20

Anesthesia management in robotic-assisted esophagectomy with triple incisions: analysis of 53 cases

  • Online:2017-05-20 Published:2017-05-20

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摘要： 达芬奇机器人辅助下食管癌三切口手术患者53例，全麻诱导后插入左双腔支气管导管，胸腔部手术时单肺通气（OLV），上 腹部手术时CO2气腹，其中7例OLV时行CO2气胸。监测术中血氧、呼吸力学及血流动力学变化。多数病人能耐受OLV及CO2 气腹，7例OLV时行CO2气胸患者中，4例出现SpO2低于90%，需要间断双肺通气或停止气胸；OLV及CO2气腹引起的血流动力 学紊乱通过血管活性药予纠正；术后发生需入ICU治疗的肺部并发症15例，住院期间无死亡病例。机器人食管癌三切口手术 的麻醉管理对麻醉医师有较高的要求，麻醉医师与术者之间的团队配合对手术成功十分重要。

Abstract: Between March, 2016 and January, 2017, 53 patients underwent robotic-assisted esophagectomy with triple incisions. All the patients were intubated with Double lumen endotracheal tub with one-lung ventilation and CO2 pneumoperitoneum, and CO2 pneumothorax was used in 7 cases. Most of the patients could tolerate OLV and CO2 pneumoperitoneum, and 4 patients with CO2 pneumothorax had hypoxemia and required double-lung ventilation or high frequency ventilation; 15 patients developed postoperative pulmonary complications and were transferred to ICU. These results suggest that CO2 pneumothorax during robotic-assisted esophagectomy with triple incision seriously disturbs pulmonary function, and careful anesthesia management is essential for preventing complications.