全身麻醉后上食管括约肌张力测定的价值探讨

The variating pressurs generated within upper esophageal sphincter after general anesthesia

目的探讨麻醉后上食管括约肌张力即上食管屏障压变化。方法选择19例择期行腹腔镜下气腹手术患者,没有食管反流疾病病史。连续测定全麻气管插管后至清醒气管拔管后上食管括约肌张力,记录气管插管后1min、气腹开始、气腹后5min、清醒期呛咳时、清醒气管拔管前后安静时的上食管括约肌张力。结果记录结果依次为:(20.85±3.06)、(21.22±2.47)、(22.05±2.45)、(132.78±15.51)、(40.33±5.09)、(29.46±3.90)cmH2O。所有张力资料均与全麻气管插管后1min做前后对比,结果显示麻醉中(包括气腹前后)上食管括约肌张力变化差异无统计学意义(P>0.05),清醒呛咳及拔气管导管前后上食管括约肌张力均较高,差异有统计学意义(P<0.05),而气腹前后比较差异虽有统计学意义(P<0.05),但差值太小无临床意义。结论全麻肌肉松弛时上食管括约肌张力无明显变化,未发现气腹对上食管括约肌张力有明显影响。呛咳会明显增加上食管括约肌张力。麻醉诱导时面罩加压峰压是否应控制在15cmH2O还待进一步研究。

Objective To determine the pressurs generated within upper esophageal sphincter after general anesthesia.Methods 19 patients,who were selected with laparoscopic pneumoperitoneum,were continuously measured the pressurs generated within upper esophageal sphincter during tracheal intubation under general anesthesia to sober extubation.Results The pressures（±sd）generated within upper esophageal sphincter at the time points（1 minute after tracheal intubation,1 minute before pneumoperitoneum and 5minutes after pneumoperitoneum,choking during resuscitation,before and after sober extubation were respectively（20.85±3.06）、（21.22±2.47）、（22.05±2.45）、（132.78±15.51）、（40.33±5.09）、（29.46±3.90）cmH2O.1 minute before pneumoperitoneum and 5 minutes after pneumoperitoneum,compared to 1 minute after tracheal intubation,the pressures were not significantly variation（P0.05）,the pressures at the others were significantly increased（P0.05）.Conclusion The pressurs generated within upper esophageal sphincter during general anesthesia will be lower than,the pressure during positive pressure ventilation with mask should be controlled under 15cmH2O.The pressurs can not still be considered affected by pneumoperitoneum.The pressurs would be significantly increased by choking.