双腔支气管插管全麻复合硬膜外麻醉行肺叶切除术临床观察.docVIP

双腔支气管插管全麻复合硬膜外麻醉行肺叶切除术临床观察【摘要】目的:探讨双腔支气管插管全麻复合硬膜外麻醉下行肺叶切除术的临床应用体会。方法:择期开胸肺叶切除术患者30例,ASA 1~2级,硬膜外穿刺后平卧行双腔支气管插管,观察患者术中术后的情况。结果:双腔支气管插管全麻复合硬膜外麻醉能很好地完成开胸肺叶切除术,术中患者生命征平稳,双肺隔离彻底,避免了双肺交叉感染。全麻药用量少,苏醒彻底,迅速,可控性好。术后镇痛效果好,有助于患者早期咳嗽排痰,对患者后期恢复有利。? 【关键词】双腔支气管插管;硬膜外麻醉;肺叶切除术? 【中图分类号】R246.2 【文献标识码】B 【文章编号】1008-6455(2010)07-0056-02 【Abstract】Abstract:goal discussion pair bronchial tube inserts a tube outside the general anesthesia compound hard membrane to anaesthetize the downward lobe of the lung excision method the clinical practice experience.Methods:The picks an auspicious date the chest lobe of the lung excision method patient 30 examples, the ASA 1~2 levels, outside after hard membrane puncture, the horizontal good pair bronchial tube intubation, after observing in the patient technique the technique situation. Results:the pair bronchial tube inserts a tube outside the general anesthesia compound hard membrane the anaesthesia to be able to complete start the chest lobe of the lung excision method well, in the technique the patient life drafts steadily, the double lung isolation was thorough, has avoided the double lung cross infection. The general anesthesia therapy dose are few, regains consciousness thoroughly, rapid, the controllability is good. After the technique, the analgesic effect is good, is helpful to a patient early time cough row of phlegm, later period restores to the patient advantageously. ? 【Key words】Pair bronchial tube inserts a tube outside the hard membrane to anaesthetize the lobe of the lung excision method 肺叶切除术是胸外科常见的手术,双腔支气管插管是胸外科手术麻醉中常采用的插管方式,它可以有效的阻隔两侧的肺,并能为手术提供良好的操作条件。而硬膜外麻醉应用到开胸手术也已经有了成熟的经验,它可以让患者术后采用硬膜外镇痛这种满意的镇痛方式,同时也能减少术中全麻药用量,近期我们对30例患者进行了这种麻醉方式并取得较好效果。? 1 一般资料? 择期开胸肺叶切除术患者30例,ASA1~2级,男22例,女8例,年龄35~68岁。其中肺癌患者18例,肺脓肿患者5例,肺大泡患者3例,支气管扩张患者4例。术前伴随有一种或一种以上内科疾病的16例,包括心电图异常的5例,高血压患者8例,慢支患者7例,糖尿病患者2例。术前要求吸烟患者禁烟至少一星期,高血压患者血压控制在150/95以下,糖尿病患者血糖控制在9mmol/L以下,术前有呼吸道感染的应用抗生素加以控制,冠心病患者控制心率,纠正心律不齐,保持患者安静。? 2 麻醉方法? 患者麻醉前8小时禁食水,术前访视时重点评