腹腔镜结直肠癌手术的麻醉管理

目的总结腹腔镜结直肠癌手术麻醉管理的经验。方法回顾性分析2007年10月~2009年6月178例腹腔镜下结直肠癌手术的麻醉资料,其中结肠癌根治手术76例,直肠癌根治手术102例,98例(55.1%)合并一种以上的全身性疾病。均采用气管内插管全身麻醉,术中监测无创血压(blood pressure,BP)、心率(heart rate,HR)、脉搏血氧饱和度(saturation of pulse oxygen,SpO2)、呼气末CO2分压(end-tidal carbon dioxide pressure,PETCO2)。结果气腹后10min平均动脉压(mean arterial pressure,MAP)、HR、PETCO2较气腹前显著性升高,经处理,气腹后30min MAP、HR明显降低,PETCO2无明显升高。术中130例(73.0%)使用一种以上的血管活性药,61例(34.3%)使用2种以上的血管活性药。132例在手术间或麻醉恢复室拔除气管导管,停止麻醉至拔除气管导管时间(39±25)min(6~140min),恢复室停留时间(71±36)min(25~209min)。46例(25.8%)带气管导管送入ICU病房。结论术前全面评估病人,完善围术期监测,加强术中管理,及时纠正处理合并症,腹腔镜结直肠癌手术患者的麻醉是安全的。

Anesthesia Management during Laparoscopic Colorectal Surgery

Objective To summarize our experience in anesthesia management for patients undergoing laparoscopic colorectal surgery.Methods The perioperative data of 178 patients with colorectal carcinoma who underwent laparoscopic surgery in our hospital from October 2007 to June 2009 were analyzed retrospectively.Among the patients,76 received radical colonic cancer resection and 102 underwent radical rectal cancer resection;98 of the patients（55.1%）had concomitant systemic diseases.All the patients received general anesthesia with tracheal intubation.Continuous electrocardiogram,arterial blood pressure,pulse oximetry,and end-tidal carbon dioxide pressure（PETCO2）were monitored during the surgery.Results The mean arterial pressure（MAP）,heart rate（HR）and PETCO2 of the patients significantly increased at 10 min after pneumoperitoneum;after adjusting ventilation and giving drugs MAP and HR decreased significantly,but PETCO2 didn＇t change.During the operation,130 patients（73.0%）received more than one kind of vasoactive drug,and 61 patients（34.3%）received more than two kinds of the drug.Extubation was carried out in operating room or PACU,the average extubation time was（39±25）minutes（6-140 minutes）,and the average PACU stay was（71±36）minutes（25-209 minutes）.46 patients（25.8%）were transferred to ICU after the operation with endotracheal tube held in place.Conclusion With systemic pre-operative evaluation,perioperative monitor,intraoperative management,and timely treatment for complications,laparoscopic colorectal surgery can be safe.