双腔支气管插管全身麻醉在腹腔镜下巨大食管裂孔疝修补术中的应用

Application of double lumen bronchus intubation in laparoscopic giant esophageal hiatal hernia repair

目的探讨双腔支气管插管全身麻醉在腹腔镜巨大食管裂孔疝修补术中的应用效果及安全性。方法回顾性分析2015年10月至2017年12月,新疆维吾尔自治区人民医院收治22例巨大食管裂孔疝患者的病例资料,均在双腔支气管插管全身麻醉下行腹腔镜下巨大食管裂孔疝修补术,统计分析术中相关麻醉监测指标。结果 22例腹腔镜巨大食管裂孔疝修补术均获成功,无中转开腹。手术时间158~246(173. 46±18. 33) min,术中出血15~100(46. 38±5. 27) ml。在麻醉诱导期间加压呼吸和维持期间容控呼吸,患者生命体征平稳,无心血管系统和呼吸系统应激反应的发生。结论双腔支气管插管全身麻醉下行腹腔镜巨大食管裂孔疝修补术,在保证机体供氧的情况下,减少双肺通气作功和内容物在胸腔内的压力,减轻了对心泵及循环的影响,术中安全有效,值得临床推广。

Objective To investigate the efficacy and safety of general anesthesia with double lumen bronchial intubation in laparoscopic repair of giant hiatal hernia. Methods Statistical analysis 22 patients of giant hiatal hernia in our hospital from October 2015 to December 2017.There were 14 males and 8 females,aged 35~68（42.37±4.28）years.All of them were underwent laparoscopic repair of giant hiatal hernia in general anesthesia with double lumen bronchial intubation.Statistical analysis of intraoperative anesthesia monitoring index. Results 22 cases of laparoscopic giant hiatal hernia repair were successful,There was no transit to open the abdomen.The operative time was 158~246（173.46±18.33）min,and the intraoperative bleeding was15~100（46.38±5.27）ml.During anesthesia induction and maintenance,the vital signs of patients were stable and no cardiovascular and respiratory stress reactions occurred. Conclusion Laparoscopic repair of giant hiatal hernia was performed under double lumen bronchial intubation under general anesthesia.Under the condition of ensuring oxygen supply to the body,the pressure of work and contents of double lung ventilation in the thoracic cavity was reduced,and the effect on cardiac pump and circulation was alleviated.The operation is safe and effective,and it is worth popularizing.