静脉全身麻醉在经皮肝穿刺胆道引流术中的应用

The application of intravenous general anesthesia in percutaneous transhepatic biliary drainage

目的通过局部麻醉与静脉全麻比较,探讨静脉全麻在经皮经肝胆道引流(PTBD)手术中的安全性与有效性。方法收集2012年10月至2015年8月125例行PTBD治疗患者的临床资料。其中48例患者采用局部麻醉,77例采用静脉全麻。观察患者术中及术后疼痛情况、心率及血压,随访观察手术操作时间,患者术后疼痛持续时间及穿刺相关并发症发生率。结果静脉全麻组术中仅5例(6.5%)出现轻度疼痛,术后8例(10.4%)轻度疼痛,明显低于局部麻醉组(P<0.01),疼痛评分亦低于局部麻醉组(P<0.05)。局部麻醉组术中患者心率、血压较术前、术后明显升高且波动较大,静脉全麻组术中患者心率、血压较术前、术后降低,但波动较小。局部麻醉组手术操作时间长于静脉全麻组(P<0.05)。静脉全麻组术后疼痛持续时间明显短于局部麻醉组(P<0.05)。手术相关并发症方面,局麻组3例患者发生肝动脉损伤,2例出现胆心反射综合征,2例出现胸膜损伤,静脉全麻组仅2例出现肝动脉损伤,无患者出现其他手术相关并发症。2组患者均无手术相关性死亡。结论 PTBD术中应用静脉全麻可有效降低手术风险,缩短手术时间并减轻手术痛苦,增加舒适性,值得临床应用推广。

Objective To investigate the safety and effect of percutaneous transhepatic biliary drainage （PTBD） performed under intravenous general anesthesia by comparing PTBD performed under local anesthesia. Methods The clinical data of 125 patients, who received PTBD during the period from October 2012 to August 2015, were retrospectively analyzed. Of the 125 patients, intravenous general anesthesia was employed in 48 and local anesthesia was adopted in 77. The intraoperative and postoperative pain degree, heart rate and blood pressure, the operation time, duration of postoperative pain and incidence of puncture- related complications were recorded. Results In intravenous general anesthesia group, only 5 patients （6.5%） complained of mild pain during the operation and 8 patients （10.4%） had mild pain after the operation, which were significantly lower than those in local anesthesia group （P〈0.01）, and the visual analog score （VAS） of intravenous general anesthesia group was much lower than that of local anesthesia group （P〈 0.05）. In local anesthesia group the intraoperative heart rate and blood pressure were obviously increased with large fluctuation when compared with the preoperative and postoperative data, while in intravenous general anesthesia group the intraoperative heart rate and blood pressure were decreased with less fluctuation when compared with the preoperative and postoperative ones. The operation time of local anesthesia group was markedly longer than that of intravenous general anesthesia group （P〈0.05）. The duration of postoperative pain in intravenous general anesthesia group was strikingly shorter than that in local anesthesia group （P〈 0.05 ）. With aspect to puncture-related complications, in local anesthesia group hepatic artery injury occurredin 3 patients, biliary-cardiac reflex syndrome in 2 patients and pleural injury in 2 patients, while in intravenous general anesthesia group only 2 patients developed hepatic artery injury; no other procedure- related complications or procedure-related death occurred. Conclusion In performing PTBD, the use of intravenous general anesthesia can effectively reduce the risk of operation, shorten the operation time, relieve the pain and improve the patient＇s comfortableness, therefore, it is worthy of clinical application and promotion.