同期电视胸腔镜双侧肺大疱手术的麻醉处理(1)
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[摘要] 目的 探讨同期电视胸腔镜双侧肺大疱手术的麻醉处理要点。 方法 对81例双侧肺大疱患者在电视胸腔镜下同期行肺大疱切除修补术的麻醉过程进行回顾性分析。结果 手术均顺利完成，无麻醉意外及围手术期死亡。无通气侧肺大疱破裂；单肺通气时一过性低氧血症(SpO2<90%)5例，复张性肺水肿3例，室性早搏1例，经处理后均恢复。结论 手术前气胸侧胸腔闭式引流，双腔支气管插管确保双肺分隔，加强围术期呼吸循环监测，防止出现张力性气胸和复张性肺水肿，良好的术后镇痛，是同期胸腔镜双侧肺大疱手术麻醉的可靠保证。
[关键词] 双侧肺大疱；电视胸腔镜；同期手术；麻醉
[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701(2011)24-127-02
Anesthesia for Video-assisted Thoracic Surgery of Bilateral Lung Bullous
ZHAO Weishan HUANG Yizhen GONG Zhiping LIU Xiaosu YIN Fei
Anaesthesia Department of Nanjing City Chest Hospital，Nanjing 210029，China
[Abstract] Objective To investigate the method of the anesthesia treatment about the lung operation of video-assisted thoracoscopic bilateral bullae. Methods A retrospective analysis of the anaesthetic process in which 81 cases with lung bilateral bullae had took simultaneous operations to treat with video assistant thoracic surgery. Results All operations were successfully performed without anesthesia and perioperation death. Non ventilated lung bullae rupture；single lung ventilation during transient hypoxemia(SpO2<90%) in 5 cases，re-expansion pulmonary edema in 3 cases，1 cases of ventricular premature beats，all recovered after treatment. Conclusion Before operation pneumothorax side closed thoracic drainage，double lumen endobronchial intubation ensure double lung separation， strengthen the perioperative respiratory and circulatory monitoring，to prevent the emergence of tensile pneumothorax and reexpansion pulmonary edema，good postoperative analgesia，the lung operation anesthesia to treat with earlier thoracoscopic bilateral bullae is a reliable guarantee.
[Key words] Bilateral lung bullous；Video-assisted thoracic surgery；Simultaneous operation；Anesthesia
本院近5年来对81例双侧肺大疱(手术当时合并或不合并气胸)患者行双侧同期电视胸腔镜手术(video assistant thoracic surgery，VATS)治疗，现就麻醉处理分析如下。
1 资料与方法
1.1 一般资料
本组81例，男69例，女12例；年龄17～69岁，平均40.4岁；病程0.5～20年，均有气胸反复发作史2～12次(1例1个月内两侧交替气胸5次)。胸部X线及CT检查显示双肺可见肺纹稀疏或消失，呈典型肺大疱病变。双侧液气胸、肺组织呈不同程度萎陷者13例，单侧液气胸、肺组织呈不同程度萎陷者68例。肺组织受压为10%～90%。放置胸腔闭式引流，肺组织仍萎陷超过70%15例，50%～60%34例，30%～40%32例。胸部X线摄片显示气管明显移位者8例，心电图呈现典型肺型P波、右室高电压、右束支传导阻滞和ST-改变者13例 ......
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