发布时间：2015-01-17 来源：人大经济论坛

腹腔镜胆囊切除术麻醉管理与监测_药学专业毕业论文 【关键词】 血氧饱和度 【摘要】 目的 观察腹腔镜胆囊切除术（LC）中，血氧饱和度（SpO2）、血压（BP）的变化特点。方法 对40例胆囊结石、5例胆囊息肉患者选择气管插管静脉复合麻醉，其中5例加用硬膜外阻滞麻醉，术中观察SpO2、BP，分析术毕SpO2和拔气管导管时间。结果 术中1例出现短时间SpO2下降＜85%，2例＜95%，93%以上维持在96%～100%，术毕有40例（88.9%）SpO2维持在99%～100%，4例（8.9%）维持在97%～98%，仅有1例为96%；术中有2例BP下降至（76～85）/（48～53）mmHg，术后拔管时间最长50min，最短为5min内，平均18.1min。结论 腹腔镜胆囊切除术需CO2气腹下完成，对呼吸和循环系统有明显影响，术中连续监测SpO2、BP，有助于避免各种并发症发生。 【关键词】 胆囊切除术，腹腔镜；麻醉管理；血氧饱和度 Management and monitoring of anesthesia in laparoscopic cholecystectomy 【Abstract】 Objective To observe the changing features of oxygen saturation(SpO2） and blood pressure (BP） during laparoscopic cholecystectomy (LC）.Methods We combined tracheal intubation anesthesia and intravenous anesthesia for 40 gallbladder calculus patients and 5 gallbladder polyp patients.Additionally,we gave epidural blockade anaesthesia for 5 patients among the 45 foresaid ones.Observing SpO2 and BP during the surgery,and analyzing the SpO2 and the time of decannulating the endotracheal tube after the surgery were carried out.Results During the surgery,only 1 patients SpO2 descended less than 85% for a while,2 patients descended less than 86% to 95%,while the balance patients stayed between 96% and 100%.After the surgery,40 patients (88.8%） SpO2 stayed between 99% and 100%,4 patients(8.8%） stayed between 97% and 98%,only 1 patients stayed 96%.During the surgery,2 patients BP descended to 76～85/48～53mmHg.It took 5 to 50 minutes to decannulate the endotracheal tube after the surgery,and the average time was 18.1 minutes.Conclusion The laparoscopic cholecystectomy (LC） needs to be performed with the CO2 insufflation.Since the laparoscopic cholecystectomy (LC） affects respiratory system and circulatory system obviously,continuous monitoring the SpO2 and BP can help to prevent various complications during the surgery. 【Key words】 cholecystectomy,laparoscopic;anaesthesia management;oxygen saturation 腹腔镜胆囊切除术（LC）具有手术创伤小、恢复快等特点，已被广泛应用。但由于腹腔镜胆囊切除术需要向腹腔内注入二氧化碳造成气腹，腹压的上升和二氧化碳吸收入血，将对呼吸功能带来影响［1］。现从我院所开展的数百例腹腔镜手术患者中，随机抽取45例腹腔镜胆囊切除术患者的资料，对其围术期麻醉管理及监测进行分析，总结如下。 1 资料与方法 1.1 一般资料 本组45例，男24例，女21例，年龄23～81岁，平均（62.24±15.3）岁。ASA Ⅰ～Ⅲ级，Ⅰ级8例，Ⅱ级33例，Ⅲ级4例。既往有高血压史者8例，高血压合并冠心病2例，糖尿病2例，心电图异常9例，主要表现窦性心动过缓，完全性右束支传导阻滞，各种类型期前收缩及STT改变等。其中胆囊结石40例，胆囊息肉5例。 1.2 方法 所有病例均选择气管内插管静脉复合麻醉，其中5例加用硬膜外阻滞麻醉。术前肌注苯巴比妥钠0.1g、阿托品0.5mg或东莨菪碱0.3mg。气管插管诱导，乐维静2.5mg/kg，芬太尼5μg/kg，卡肌宁0.1mg/kg。机控呼吸。潮气量8～10ml/kg，频率14～16次/min，呼吸比为1∶2。术中密切观察生命体征，常规应用多功能监护仪连续监测心率、SpO2、SBP、DBP、MAP、心电图等。麻醉维持安氟醚或异氟醚，静脉滴注乐维静，滴注速度根据患者情况而定，其中5例硬膜外穿刺者常规硬膜腔注入1.5%利多卡因。