腔镜甲状腺手术的麻醉管理

Anesthetic Management of Patients Undergoing Endoscopic Thyroid Operation

目的总结腔镜甲状腺手术的麻醉管理经验。方法2007年6月~2009年6月,在全麻下行胸前壁和乳晕入路或腋窝乳晕入路腔镜甲状腺手术22例,分析充气前、充气后30 min的收缩压（SBP）、舒张压（DBP）、心率（HR）、呼气末CO2分压（PETCO2）。结果12例（54.5%）在手术室内拔管,10例（45.5%）在麻醉后监护室（PACU）拔管,手术结束至拔除气管导管时间4~52 min,平均15.5 min。充气后30 min,SBP、DBP、HR的变化与充气前比较差异无显著性（P〉0.05）,PETCO2与充气前比较显著升高（P〈0.05）,但都在正常范围之内。结论腔镜甲状腺手术中,颈部CO2充气可造成PETCO2显著升高,只有加强呼吸管理并严格拔管指征,才能保证病人的安全。

Objective To summarize our experiences on anesthetic management of endoscopic thyroid operation.Methods We retrospectively reviewed the clinical data of 22 patients receiving endoscopic thyroid operation under general anesthesia from June 2007 to June 2009.The systolic blood pressure（SBP）,diastolic blood pressure（DBP）,end-tidal carbon dioxide pressure（PETCO2）,and heart rate（HR） before and 30 min after CO2 insufflation were recorded and analyzed. Results Tracheal catheters were pulled out in operation room in 12 patients（54.5%）,and in post-anesthetic care unit（PACU） in 10 patients.The mean decannulation time ranged from 4 to 52 min with a mean of 15.5 min.According to our record,PETCO2 were significantly higher at 30 min after CO2 insufflation than pre-insufflation（P0.05,however,both were in the normal range）;whereas no significant differences were observed in SBP,DBP,and HR between the two time points（P0.05）.Conclusions CO2 insufflation during endoscopic thyroid operation can increase the PETCO2 significantly.Careful respiratory management and strict extubation indications are necessary to ensure the safety of patients.