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双侧同期胸科手术的麻醉

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DOI:
作者:
周玉萍
zhouyuping
作者单位:
上海市肺科医院
shanghai pulmonary hospital
关键词:
双侧同期 胸科手术 麻醉
Bilateral simultaneous; Thoracic surgery; Anesthetic
摘要:
[摘要] 目的 总结双侧同期胸科手术的麻醉经验，旨在探讨双侧同期胸科手术的最佳麻醉方案。方法 1 术前复习病史，参加外科术前讨论明确手术目的；2 根据病人一般情况、术前肺功能、疾病位置、范围、手术范围与步骤决策是否可行双侧同期手术；3依据不同种类疾病、不同手术方案，个体化确定麻醉和呼吸管理的方法。结果 2005年8月-2010年11月共完成33例，其中双侧气胸肺大疱行大疱切除12例，双侧肺癌行两侧肺叶切除8例，一侧肺癌对侧肺结节行一侧肺叶切除对侧肺部分切除9例，两肺结节肺活检4例。麻醉均获得满意的效果。麻醉时间4.201.59h，手术时间3.891.65h， ICU停留时间4.473.03d，出院时间12.436.16d。结论 双侧同期行胸科手术安全有效，麻醉处理的关键在于依据手术种类和肺功能情况评估病人可否同期手术，谨慎实施先完成手术侧的单肺通气管理，具有挑战性。
Anesthetic management for bilateral simultaneous thoracic surgery Yuping Zhou, Mingxing Li Department of anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China. [abstract] object To explore the optimal Anesthetic project from the Anesthetic experiences of bilateral simultaneous thoracic surgery. Method 1) Reviewed the medical history and participated in the epicrisis; 2) The decision that whether patient accept bilateral simultaneous thoracic surgery was gotten according to the following respects of patient: general conditions, preoperation PF, location and range of the disease, step and range of operation. 3) Determined the management methods of anesthesia and respiration individually according to the different kind of disease and the different project of operation. Result 33 cases underwent bilateral simultaneous thoracic surgery from August 2005 to November 2010, and all got satisfactory anesthetic, in which there were 12 cases undergoing pulmonary bulla resection for double bunamiodyl, 8 cases undergoing pulmonary lobectomy for bilateral lung cancer, 9 cases undergoing pulmonary lobectomy for lung cancer on one side and pneumoresection for lung nodule on the other side, and 4 cases undergoing biopsy for lung nodule. Anesthetic duration is 4.2±1.59 hours, operation duration was 3.89±1.65 hours, retention duration in ICU is 4.47±3.03 hours, and hospitalization duration is 12.43±6.16 days. Conclusion it was safe and effective undergoing bilateral simultaneous thoracic surgery, the key points for anesthesia were that decideing whether the patient could endure bilateral simultaneous thoracic surgery according to the kind of operation and PF, and executing one-lung ventilation management of the first-operated side prudently, that was challenging.

 

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