肝硬化门脉高压症患者手术90例麻醉管理

Anesthesia for 90 patients with hepatic cirrhosis induced portal hypertension

目的:探讨肝硬化门脉高压症患者手术麻醉管理的特点。方法:回顾分析90例肝硬化门脉高压症手术临床麻醉资料,其中上消化道大出血(失血性休克)急诊手术10例。采用气管内全麻45例,气管内全麻+连续硬膜外麻醉43例,连续硬膜外麻醉2例。结果:除1例术终广泛渗血,血压不稳,带气管导管回病房外,其余87例均于手术结束30 min内顺利拔除气管导管;术后一侧声带麻痹1例,保守治疗后声嘶症状消失;术终并发张力性气胸1例,立即行胸腔闭式引流;无椎管内麻醉并发症,全麻者无术中知晓发生。结论:肝硬化门脉高压症患者麻醉前应正确评估,合理选择麻醉方案,重视低蛋白血症和贫血程度,加强呼吸循环功能监测。

Objective：To investigate the characteristics of anesthesia in patients with hepatic cirrhosis induced portal hypertension. Methods：The clinical data of 90 cases of portal hypertension induced by hepatic cirrhosis were analyzed retrospectively. Ten of the cases with massive hemorrhage of gastrointestinal tract （hemorrhagic shock ） received emergency operation. General anesthesia was applied to 45 cases, general anesthesia combined with epidural anesthesia to 43 cases and epidural anesthesia to 2 cases. Results： Excepting for one case who went back to the ward for capillary hemorrhage and unstable blood pressure without pulling off the endotracheal tube,the endotracheal tubes in other 87 cases were successfully pulled out 30min after the operation. One case suffered from paralysis of the vocal cord, and hoarseness disappeared after symptomatic treatment ; one case presented tension pneumothorax and received incision and drainage in time;hypoglycemia occurred in one case. No complication of intravertebral anesthesia or intraoperative awareness occurred. Conclusions： Anesthesia methods should be selected rationally for patients with hepatic-cirrhosis-induced portal hypertension. In any circumstances, hypoproteinemia and nutritional anemia must be taken into account and detection of breath circulation must be strengthened.