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全麻内镜粘膜下剥离术中上消化道不同部位蠕动的比较和处理
Comparison of the vigorous peristalsis of different parts of upper gastrointestinal tract in the process of ESD under general anesthesia and the corresponding treatment
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DOI:
作者:
王飞飞,谢郭豪,方向明
WANG Feifei,XIE Guohao, FANG Xiangming
作者单位:
浙江大学医学院附属第一医院
The First Affiliated Hospital of Medical school of Zhe Jiang University
关键词:
全身麻醉; 内镜粘膜下剥离术;上消化道;胃肠道蠕动
general anesthesia; ESD; upper gastrointestinal tract; gastrointestinal peristalsis.
摘要:
目的:观察比较插管全麻内镜粘膜下剥离术(endoscopic submucosal dissection,ESD)中上消化道不同部位蠕动情况及相应的处理,为探讨ESD安全科学的麻醉管理提供参考依据。 方法:序贯收录76例病人依病变部位不同分为胃窦胃角组(A,n=25)、胃体胃底组(B,n=21)和食道和食道胃交界组(C,n=30)。患者静脉快诱导气管插管,术中以持续泵注异丙酚、间断静注芬太尼维持麻醉深度。若术中出现影响操作的消化道剧烈蠕动,给予静注消旋山莨菪碱10mg补救处理。录像记录ESD操作过程,用于蠕动和操作的评估;记录术前患者基本情况;记录手术时间,麻醉时间,拔管时间,复苏室时间,丙泊酚用量和术后24小时的并发症情况。 结果:与A组相比,B组和C组的手术时间和麻醉时间较长(p<0.05)。A组影响操作的剧烈蠕动的发生率为68.0%,显著高于B组的4.8%和C组的3.3%(p<0.01);A组的蠕动评分和操作评分显著高于B组的蠕动评分和操作评分(p<0.01)。A组的操作评分显著高于C组的操作评分(p<0.01)。术中补救静注消旋山莨菪碱10mg可有效抑制各组发生的影响操作的蠕动亢进。 结论:插管全麻下上消化道行ESD术中剧烈蠕动易发生于胃窦胃角处病灶的手术过程,术中静脉注射消旋山莨菪碱10mg能有效抑制蠕动,有利于手术操作。
Objective To compare the incidence of vigorous peristalsis of different parts of upper gastrointestinal tract in endoscopic submucosal dissection (ESD) under tracheal intubation general anesthesia and treatments. Methods 76 patients were assigned to three group: gastric antrum and gangle (A), gastric body and fundus (B) and esophagus and esophagogastric junction(C). Anesthesia was induced with intravenous anesthetic agents and maintained with continuous intravenous injection of propofol and intermittent intravenous injection of fentanyl. Racemicanisodamine 10mg was infused on the occurrence of vigorous peristalsis. The process of ESD operation was recorded by endoscopic video system for evaluation of peristalsis and operation. Preoperative basic conditions of patients, operation time, anesthesia time, extubation time, recovery time, dosage of propofol and postoperative patient conditions were also recorded. Results Compared with group A, group B and group C had longer operation time and anesthesia time (p<0.05). The proportion of patients with vigorous peristalsis was significantly higher in group A(68.0%) than group B(4.8%) and C (3.3%)(p<0.01). The peristalsis score and operation score of group A was significantly higher than that of group B (p<0.01). The operation score of group A was significantly higher than the group C (p<0.01). Intraoperative use of raceanisodamine 10mg can inhibit these vigorous peristalsis of each group. Conclusion In the process of ESD under general anesthesia, the incidence of vigorous peristalsis in patients with foci located on gastric antrum and angle was high and intraoperative use of raceanisodamine can inhibit these peristalsis.The incidence of vigorous peristalsis in patients with foci located on gastric body and fundus, esophagus and esophagogastric junction was low, and no remedy was required.
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