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腹腔镜下子宫颈癌根治术的麻醉处理 被引量:5

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摘要 目的探讨腹腔镜下子宫颈癌根治术的麻醉处理方法。方法 2007年3月~2009年12月21例腹腔镜子宫颈癌根治术采用气管插管静吸复合全身麻醉,术中监测有创血压(BP)、心电图(ECG)、经皮脉搏血氧饱和度(SpO2)、体温、呼气末二氧化碳分压(PETCO2),检测血气、电解质和血糖(Glu)。右颈内静脉穿刺开放输液通路和监测中心静脉压(CVP)。机械控制通气,潮气量(VT)8~10 ml/kg,根据血气分析和PETCO2调整呼吸次数。术中维持血流动力学稳定,必要时应用血管活性药。术毕清醒拔除气管导管后返病房,术后行静脉自控镇痛。分别记录气腹前,气腹后1、2、3、4 h和放气后15 min的HR、MAP、CVP、气道压(Paw)、血气、电解质和测鼻咽体温。术后24 h及48 h采用视觉模拟评分法(visual analogue scale,VAS)行镇痛评分。结果均在腹腔镜下顺利完成子宫颈癌根治术。HR在气腹后3 h和放气后15 min较气腹前增快(P〈0.05)。MAP气腹前后无明显变化(P〉0.05)。术中1例应用阿托品,1例应用麻黄碱,2例应用艾司洛尔,1例应用乌拉地尔。CVP和Paw在气腹中各时间点均较气腹前升高(P〈0.01),PETCO2、PaCO2气腹后3 h较气腹前升高(P〈0.05)。Hb在气腹后3 h、放气后15 min降低(P〈0.01)。Glu于气腹后3 h、4 h及放气后15 min高于气腹前(P〈0.05),1例术中血糖超10 mmol/L,给予胰岛素治疗。体温在气腹后4 h和放气后15 min低于气腹前(P〈0.05)。气腹后4 h时2例血K+分别高达5.0、5.4 mmol/L,行控制PaCO2和呋塞米利尿处理。术后24 h和48 h的VAS评分分别为2.4±0.7和2.8±0.9。结论腹腔镜子宫颈癌根治术,围术期须加强监测;加强呼吸系统管理,及时调整呼吸参数,避免高碳酸血症;维持血流动力学、血气、电解质和血糖的稳定,避免低体温;虽然是微创手术,但术后仍需加强术后镇痛,增加患者舒适度,促进恢复。
出处 《中国微创外科杂志》 CSCD 2011年第3期204-206,209,共4页 Chinese Journal of Minimally Invasive Surgery
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参考文献7

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