食管癌三野清扫根治术后呼吸衰竭发生率与麻醉选择、管理的关系

Relationship between the occurence of acute respiratory failure after subototal esophagectomy and three-field lymphadenectomy and the choice of anesthesia and management

目的:探讨食管癌三野清扫根治术后呼吸衰竭的发生率与麻醉选择及围手术期管理的关系。方法:2000年3月～2001年1月37例食管癌三野清扫术,其中19例行硬膜外+全身麻醉方法为Ⅰ组,18例采用硬膜外+双侧浅颈丛阻滞+全身麻醉方法为Ⅱ组,对照比较。结果:37例患者术后共有7例急性呼吸衰竭,占全组19%,经抗感染,呼吸支持全部康复,其中Ⅰ组5例,Ⅱ组2例,Ⅱ组明显优于Ⅰ组。结论:术中使用硬膜外+双侧浅颈丛阻滞+全身麻醉的方法可减少静脉麻醉药物的用量及缩短拔管时间,降低术后呼吸衰竭的发生率。但术前呼吸道的充分准备,可改善呼吸功能,术中控制输液的种类和输液量,也是预防术后发生呼吸衰竭必须注意的问题。

Purpose:To explore the relationship between the occurence of acute respiratory failure after subototal esophagectomy and three-field lymphadenectomy and the choice of anesthesia and management.Methods:From March 2000 to Janunary 2001,thirty-seven patients scheduled for subtotal esophagectomy and three-field lymphadenectomy with e- sophageal cancer,adopting the combination of epidural,cervical nerve block,and general anesthesia were studied.Re- sults:Seven cases out of thirty-seven had acute respiratory failure,accounting for 19% in whole group.They had complete recovery after antifectious therapy and respiratory support.Conclusions:To combine the epidural,cervical nerve block and general anesthesia can reduce intravenous anesthetics use and shorten the extubation time,decrease the incidence of postop- erative respiratory failure.