冠心病患者腹腔镜胆囊切除术围麻醉期管理

PERIANESTHETIC MANAGEMENT OF PATIENTS WITH CORONARY HEART DISEASE AFTER LAPAROSCOPIC CHOLECYSTECTOMY

目的研究冠心病患者腹腔镜胆囊切除术(LC)围麻醉期管理。方法142例冠心病患者行LC术,选择依托咪酯、芬太尼静脉全麻,根据对血压、心率、心电监测结果,给予硝酸甘油、艾司诺尔等处理以维持血流动力学平稳。结果135例患者停药后5m in清醒,呼吸功能和肌张力恢复,7例患者10m in清醒,恢复呼吸功能和肌张力,142例患者围麻醉期心血管系统平稳,无一例发生心衰,心肌梗塞,室性心律失常和麻醉意外等并发症。术毕恢复良好。结论以芬太尼、依托咪酯麻醉药物为主,术中适当降低CO2气腹压力,充分供氧,酌情使用硝酸甘油、艾司洛尔,对保持心血管系统的稳定有一定的作用。LC对患者的创伤及刺激均较小,手术时间也较短,维持一定深度的麻醉即可完成手术。

Objective To investigate the perianesthetic management of patients whti coronary heart disease after laparoscopic cholecystectomy（LC. ）Methods 142 patients with coronary heart disease were anesthetized with fentanyl and etomidate during operation. Nitroglycerin and esmolo were administrated to maintain the stability of hemodynamics according to the readings of blood pressure,heart rate and electrocardio-monitoring. Result 135 patients Came into consciousness and recovered their respiratory function and muscular tension 5 minutes after withdrawl ,while 7 patients took 10 minutes. In all cases , the complications such as heart failure ,myocardial infarction, ventricle arrhythmia and anesthetic accident didn＇t happen and the circulatory system function was stable during the peri-anesthesia period. These patients＇ postoperative recovery was also good. Conclusion Using fentanyl and etomidate mainly,decreasing the Co2 pneumoperitoneum pressure and supplying oxyegn sufficiently, administrating reasonable nitroglycerin and esmolo in operation are helprul to maintain the stability of circulatory system. LC can be accmplished with reasonable anesthesia because it has little trauma and stimulation on patients and doesn＇t take much time.