电视胸腔镜手术的麻醉处理分析

目的探讨电视胸腔镜手术的麻醉方法和相关并发症的处理。方法分析117例电视胸腔镜手术的麻醉处理过程。男性81例，女性36例，平均年龄41岁，ASAⅠ～Ⅲ级。在双腔支气管插管全身麻醉下实行胸外科手术，术中单肺通气，严密监测循环、呼吸等功能。结果全组病例均使用Robertshaw双腔支气管导管插管，其中91例插管一次性成功，19例多次调整后成功，4例经纤维支气管镜定位成功，3例换小号双腔管插管成功。术中22例出现低氧血症，1例术中双腔支气管导管退出，2例出现复张性肺水肿，无死亡病例。结论正确掌握双腔支气管插管技术，加强围术期SpO2监测、必要时采用双肺通气，及时诊治并发症，可提高电视胸腔镜的安全性。

Analysis on Anesthetic Management of Video-assisted Thoracoscopic Surgery

Objective To explore the anesthetic management,prevention and treatment of the complications of video-assisted thoracoscopic surgery（VATS）. Methods One hundred and seventeen patients,male 81 and female 36,mean age 41years,ASA grade Ⅰ-Ⅲ,underwent VATS were included. After intravenous anesthetic induction,double lumen endobronchial tubes （DLT）were inserted. Anesthesia was maintained by intravenous and inhaled anesthetics and one-lung ventilation was used. Respiratory and circulatory parameters were monitored by Agile multifunction monitor. Results The intubafing effect was satisfactory. The perioperafive complications included hypoxemia 22 cases,double-lumen endobronchial tube disengaging 1 case and reexpansion pulmonary edema 2 cases. There was no anesthetic or operative mortality. Conclusion Adequate preoperative preparation is important for anesthesia for VATS. It is essential for proper DLT and one-lung ventivation during operation. Intensive monitoring at the perioperafive period and prevent and treat the complications promptly can enhance the safety of anesthesia for VATS.