5例肌肉萎缩性脊髓侧索硬化症合并胆道结石患者腹腔镜手术麻醉的回顾性分析

Retrospective Analysis of Laparoscopic Anesthesia Surgery in 5 Patients with Amyotrophic Lateral Sclerosis Combined with Bile Duct Stones

目的肌肉萎缩性脊髓侧索硬化症(ALS)合并胆道结石患者腹腔镜手术麻醉的回顾性分析。方法ALS患者5例,3男2女,年龄48~61岁,体重47~68 kg,ALS病程6~11年。因胆道结石1例需行腹腔镜胆总管切开取石、T管引流术,4例腹腔镜胆囊切除术。5例患者均选择全身麻醉,具体方法为采取镇静药物辅助下清醒气管插管后,静注咪达唑仑0.05 mg/kg、依托咪酯0.2 mg/kg、舒芬太尼10μg麻醉诱导。麻醉维持吸入1~3%七氟醚、泵注瑞芬太尼0.1~0.3μg/(kg·min)。容量控制通气,VT8 ml/kg,I∶E 1∶2,RR 10~14次/min,调整呼吸参数使P_(ET)CO_(2)维持在35~40 mmHg。CO_(2)气腹压力设定为12 mmHg。记录和分析患者麻醉前(T_(0))、切皮前(T_(1))、气腹充盈后(T_(2))、拔除气管导管前(T_(3))、出室前(T_(4))的平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))、心率(HR)、中心静脉压(CVP),以及T_(1)、T_(2)、T_(3)的气道内吸气峰压(PpK)和平台压(Pplat)。结果5例患者麻醉效果满意,效果评价均能达到Ⅰ级。与T_(0)比较,T_(1)时HR、MAP有明显降低(P<0.05);与T_(1)比较,T_(2)时HR、MAP、PpK、Pplat有明显升高(P<0.05);与T_(2)比较,T_(3)时PpK、Pplat明显下降(P<0.05)。结论ALS患者在不使用肌松药的全身麻醉下行腹腔镜手术是安全可行的。

Objective Retrospective analysis of laparoscopic anesthesia surgery in 5 patients with amyotrophic lateral sclerosis combined with bile duct stones.Methods 5 ALS patients,3 males and 2 females,aged 48-61 years,weight 47-68 kg,and the course of ALS was 6-11 years.Laparoscopic choledocholithotomy and T-tube drainage were required for 1 case of bile duct stones,and 4 cases of laparoscopic cholecystectomy.General anesthesia was selected for all 5 patients.The specific method was to induce anesthesia by intravenous injection of midazolam 0.05 mg/kg,etomidate 0.2 mg/kg,and sufentanil 10μg after conscious tracheal intubation with the aid of sedative drugs.Anesthesia was maintained by inhalation of 1-3%sevoflurane and infusion of 0.1-0.3μg/(kg·min)of remifentanil.Volume-controlled ventilation,VT 8 ml/kg,I∶E 1∶2,RR 10-14 times/min,and breathing parameters were adjusted to maintain P_(ET)CO_(2) at 35-40 mmHg.The CO_(2) pneumoperitoneum pressure was set at 12 mmHg.Record and analyze the mean arterial pressure(MAP),pulse oximetry before anesthesia(T_(0)),before skin incision(T_(1)),after pneumoperitoneum filling(T_(2)),before removal of the tracheal tube(T_(3)),and before exiting the chamber(T_(4)).Saturation(SpO_(2)),heart rate(HR),central venous pressure(CVP),and airway peak inspiratory pressure(PpK)and plateau pressure(Pplat)at T_(1),T_(2),and T_(3).Results The anesthesia effect of 5 patients was satisfactory,and the effect evaluation could reach grade I.Compared with T_(0),HR and MAP were significantly decreased at T_(1)(P<0.05);compared with T_(1),HR,MAP,PpK,and Pplat were significantly increased at T_(2)(P<0.05);compared with T_(2),PpK and Pplat were significantly increased at T_(3).Significantly decreased(P<0.05).Conclusions Laparoscopic surgery is safe and feasible in ALS patients under general anesthesia without the use of muscle relaxants.