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

doi:10.3877/cma.j.issn.1674-6899.2015.01.005

中华胃食管反流病电子杂志 ›› 2018, Vol. 05 ›› Issue (01) : 19 -21. doi: 10.3877/cma.j.issn.1674-6899.2015.01.005

所属专题：文献；

论著

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

钮峥嵘¹, 李义亮², 徐桂萍¹, 克力木²^,^†(

)

^1. 830001　乌鲁木齐，新疆维吾尔自治区人民医院麻醉科
^2. 830001　乌鲁木齐，新疆维吾尔自治区人民医院微创、疝和腹壁外科

收稿日期:2017-12-06 出版日期:2018-02-15
通信作者: 克力木

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

Zhengrong Niu¹, Yiliang Li², Guiping Xu¹, Limu Ke²^,^†()

^1. Department of anesthesiology, People′s Hospital of Xinjiang Uygur Autonomous Region, Urumuqi 830001, China
^2. Department of Minimally invasive Surgery, Hernia and abdominal wall Surgery, People′s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Urumuqi 830001, China

Received:2017-12-06 Published:2018-02-15
Corresponding author: Limu Ke
About author:
Corresponding author: Ke Limu, Email: klm6075@163.com

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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。

关键词: 疝，食管裂孔, 全身麻醉, 腹腔镜

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.

Key words: Hernia, hiatal, Laparoscopic, General anesthesia

表1 22例患者循环及血气各项监测指标变化(±s)

监测项目	麻醉诱导前双肺通气	气腹前单肺通气	气腹后单肺通气	将疝内容物回纳腹腔后双肺通气	手术完毕麻醉苏醒后
HP(次/min)	95.43±15.32	84.35±12.44	82.27±11.46	68.83±9.14	93.75±8.32
SB(mmHg)	148.81±12.73	115.43±18.11	138.44±9.67	117.26±8.42	151.23±14.51
DB(mmHg)	75.46±8.24	68.52±8.26	69.43±7.52	55.49±7.22	84.32±14.28
PaCO₂(mmHg)	53.17±4.21	48.51±3.27	44.28±5.27	41.16±10.28	37.58±7.29
PaO₂(mmHg)	88.42±8.25	187.24±43.16	173.16±36.51	243.85±48.37	118.44±33.45
SpO₂	95.24±2.44	96.17±5.43	97.22±3.55	98.46±3.71	96.73±2.66
PH	7.35±0.16	7.38±0.24	7.43±0.54	7.44±0.31	7.38±0.22
AB	22.43±1.42	22.73±2.84	23.69±2.76	25.81±3.46	22.78±3.15
ETCO₂(mmHg)	42.88±6.28	41.46±3.22	42.63±2.57	45.16±2.81	43.76±1.87
PEAK(cmH₂O)	自主呼吸	17.59±4.22	21.57±4.81	22.84±3.16	自主呼吸
VT(ml)	356.48±44.26	324.59±46.57	358.47±42.33	428.76±55.18	461.37±41.28
呼吸频率(次/min)	24.56±4.23	22.47±4.28	19.44±2.57	18.46±2.36	21.46±1.87
ECG	窦性心律	窦性心律	窦性心律	窦性心律	窦性心律

表1 22例患者循环及血气各项监测指标变化(±s)

监测项目	麻醉诱导前双肺通气	气腹前单肺通气	气腹后单肺通气	将疝内容物回纳腹腔后双肺通气	手术完毕麻醉苏醒后
HP(次/min)	95.43±15.32	84.35±12.44	82.27±11.46	68.83±9.14	93.75±8.32
SB(mmHg)	148.81±12.73	115.43±18.11	138.44±9.67	117.26±8.42	151.23±14.51
DB(mmHg)	75.46±8.24	68.52±8.26	69.43±7.52	55.49±7.22	84.32±14.28
PaCO₂(mmHg)	53.17±4.21	48.51±3.27	44.28±5.27	41.16±10.28	37.58±7.29
PaO₂(mmHg)	88.42±8.25	187.24±43.16	173.16±36.51	243.85±48.37	118.44±33.45
SpO₂	95.24±2.44	96.17±5.43	97.22±3.55	98.46±3.71	96.73±2.66
PH	7.35±0.16	7.38±0.24	7.43±0.54	7.44±0.31	7.38±0.22
AB	22.43±1.42	22.73±2.84	23.69±2.76	25.81±3.46	22.78±3.15
ETCO₂(mmHg)	42.88±6.28	41.46±3.22	42.63±2.57	45.16±2.81	43.76±1.87
PEAK(cmH₂O)	自主呼吸	17.59±4.22	21.57±4.81	22.84±3.16	自主呼吸
VT(ml)	356.48±44.26	324.59±46.57	358.47±42.33	428.76±55.18	461.37±41.28
呼吸频率(次/min)	24.56±4.23	22.47±4.28	19.44±2.57	18.46±2.36	21.46±1.87
ECG	窦性心律	窦性心律	窦性心律	窦性心律	窦性心律

[1]	Wlrscher CJ, Claser K, Cadenstaetter M, et al.Ieefectofmedical～erapyand antireflux surgery on dysphagia in patients with gastrcesophageai reflux disease without ephageal[J]．Am J Sure, 1999, 12(4): 187-189.
[2]	Andujar JJ, Papasavas PK, Birdas T, et al.Laparoscopicrepair of largeparaesophageal hernia isassociated with alow incidenceofre currenceandre operation[J]．Surg Endosc, 2004, 18(5): 444-447.
[3]	秦鸣放，杨慧琪，王庆，等．腹腔镜食道裂孔疝修补术[J]．中国实用外科杂志，2004，24(10)：614-616.
[4]	秦鸣放，赵宏志．胃食管结合部良性疾病的腹腔镜治疗[J]．中国实用外科杂志，2010，30(3)：180-182.
[5]	Schauer PR, Ikramuddin S, Mclaughlin RH, et al.Comparison oflaparoscopie verSuflopen repair ofparaesophageal hernia[J]．Am J Surg, 1998, 17(6): 657-659.
[6]	Ciofolo MJ, Clergue F, Seebacher J, et al.Ventilatory effects of aroscopy under epidural anaesthesia[J]．Anesth Analg, 1990, 70(10): 354-357.
[7]	曲成业，赵俊．腹腔镜手术对呼吸与循环的影响[J]．国外医学麻醉学与复苏分册，1997，18(6)：97-99.
[8]	Zaninotto G, Portale G, Costantini M, et al.Objective follow up After laparoscopic repair of large type hiatal hernia[J]．World J Surg, 2008, 32(11): 1563-1565.
[9]	Granderath FA, Carlson MA, Champion JK, et al.Prosthetic closure Of the esophageal hiatus in large hiatal hernia repair and laparoscopic an tirefluxsurgery[J]．Surg Endosc, 2006, 20(8): 367-379.

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

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