全身麻醉下上消化道不同部位病变行内镜黏膜下剥离术术中消化道蠕动情况的比较和处理
发布时间：2019-03-02 10:46
【摘要】：目的比较气管插管全身麻醉下上消化道不同部位病变行内镜黏膜下剥离术(ESD)术中消化道蠕动情况并探讨处理方法。方法序贯收入浙江大学医学院附属第一医院2014年2—7月在全身麻醉下行上消化道病变ESD的患者76例,依据病变部位不同分为胃窦胃角组(25例)、胃体胃底组(21例)、食管和食管胃交界组(30例)。患者快速静脉麻醉诱导后行气管插管,术中以持续静脉泵注丙泊酚、间断静脉注射芬太尼维持麻醉深度。应用内镜影像系统记录ESD操作过程,对胃食管蠕动情况进行胃蠕动评分(食管和食管胃交界组无该项评分)和操作评分,胃蠕动评分2分定义为剧烈蠕动,操作评分2分定义为影响操作。当操作评分2分时即刻静脉注射消旋山莨菪碱10mg作为补救措施。记录手术结束至拔除气管导管的时间(拔管时间)和拔除气管导管至被准许返回病房的时间[麻醉后监测治疗室(PACU)时间]。记录在PACU和术后24h的药物不良反应和患者情况。结果胃体胃底组、食管和食管胃交界组的手术时间和麻醉时间均显著长于胃窦胃角组(P值均0.05),3组间拔管时间、PACU时间、丙泊酚用量的差异均无统计学意义(P值均0.05)。在胃蠕动评分方面,胃窦胃角组剧烈蠕动的发生率为68.0%(17/25),显著高于胃体胃底组的9.5%(2/21,P0.05);胃窦胃角组的胃蠕动评分亦显著高于胃体胃底组(P0.01)。在操作评分方面,胃窦胃角组影响操作的发生率为68.0%(17/25),显著高于胃体胃底组的4.8%(1/21)、食管和食管胃交界组的3.3%(1/30,P值均0.05);胃窦胃角组的操作评分亦显著高于胃体胃底组、食管和食管胃交界组(P值均0.01)。因剧烈蠕动影响操作的患者在给予消旋山莨菪碱后蠕动均得到明显抑制(操作评分≤2分),顺利完成手术。3组间患者在PACU中视力模糊和腹痛发生率,以及术后24h咽痛、腹痛、发热、排尿困难和恶心呕吐发生率的差异均无统计学意义(P值均0.05)。结论气管插管全身麻醉下上消化道病变行ESD术中消化道剧烈蠕动易发生于胃窦胃角处病变的手术过程中,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。
[Abstract]:Objective to compare the peristalsis of digestive tract during endoscopic submucosal exfoliation (ESD) under general anesthesia in different parts of upper gastrointestinal tract under tracheal intubation and to explore the management methods. Methods 76 patients with upper gastrointestinal disease ESD under general anesthesia from February to July 2014 in the first affiliated Hospital of Medical College of Zhejiang University were divided into two groups: gastric antrum group (25 cases), body gastric fundus group (21 cases), gastric antrum angle group (25 cases) and gastric body gastrofundus group (21 cases). Esophagogastric junction group (30 cases). After induction of rapid intravenous anesthesia, tracheal intubation was performed. Propofol was continuously injected intravenously and fentanyl was intermittently injected intravenously to maintain the depth of anesthesia. Endoscopic imaging system was used to record the procedure of ESD, and the gastroesophageal peristalsis was evaluated by gastric peristalsis score (not in the esophagus-stomach junction group) and operation score. The gastric peristalsis score was defined as severe peristalsis by the gastric peristalsis score. An operation score of 2 is defined as affecting the operation. When the operation score was 2, racemic anisodamine 10mg was injected intravenously as a remedy. Record the time between the end of the operation and the extubation of the trachea (extubation time) and the time between the extubation of the trachea catheter and the permitted return to the ward [(PACU) time in the post-anesthesia monitoring treatment room]. Adverse drug reactions and patients were recorded at PACU and 24 h after operation. Results the operation time and anesthesia time in the body stomach fundus group, esophagus and stomach junction group were significantly longer than those in the gastric antrum angle group. The extubation time and PACU time between the three groups were significantly longer than those in the gastric antrum angle group. There was no significant difference in the dosage of propofol (P < 0.05). In gastric peristalsis score, the incidence of severe peristalsis in gastric antrum angle group was 68.0% (17 / 25), which was significantly higher than that in body gastric fundus group (9.5%) (2 / 21, P0.05). Gastric peristalsis score of gastric antrum angle group was also significantly higher than that of body gastric fundus group (P0.01). In terms of operation score, the incidence of affecting operation in antral horn group was 68.0% (17 / 25), which was significantly higher than that in body gastric fundus group (4.8%) and esophagus / stomach junction group (3.3% (1 / 30), P < 0.01). (P < 0.05); The operation score of gastric antrum and gastric horn group was also significantly higher than that of body gastric fundus group, esophageal and gastroesophageal junction group (P < 0.01). The peristalsis of patients with severe peristalsis was significantly inhibited after administration of racemic anisodamine (operation score 鈮，
本文编号：2432977
[Abstract]:Objective to compare the peristalsis of digestive tract during endoscopic submucosal exfoliation (ESD) under general anesthesia in different parts of upper gastrointestinal tract under tracheal intubation and to explore the management methods. Methods 76 patients with upper gastrointestinal disease ESD under general anesthesia from February to July 2014 in the first affiliated Hospital of Medical College of Zhejiang University were divided into two groups: gastric antrum group (25 cases), body gastric fundus group (21 cases), gastric antrum angle group (25 cases) and gastric body gastrofundus group (21 cases). Esophagogastric junction group (30 cases). After induction of rapid intravenous anesthesia, tracheal intubation was performed. Propofol was continuously injected intravenously and fentanyl was intermittently injected intravenously to maintain the depth of anesthesia. Endoscopic imaging system was used to record the procedure of ESD, and the gastroesophageal peristalsis was evaluated by gastric peristalsis score (not in the esophagus-stomach junction group) and operation score. The gastric peristalsis score was defined as severe peristalsis by the gastric peristalsis score. An operation score of 2 is defined as affecting the operation. When the operation score was 2, racemic anisodamine 10mg was injected intravenously as a remedy. Record the time between the end of the operation and the extubation of the trachea (extubation time) and the time between the extubation of the trachea catheter and the permitted return to the ward [(PACU) time in the post-anesthesia monitoring treatment room]. Adverse drug reactions and patients were recorded at PACU and 24 h after operation. Results the operation time and anesthesia time in the body stomach fundus group, esophagus and stomach junction group were significantly longer than those in the gastric antrum angle group. The extubation time and PACU time between the three groups were significantly longer than those in the gastric antrum angle group. There was no significant difference in the dosage of propofol (P < 0.05). In gastric peristalsis score, the incidence of severe peristalsis in gastric antrum angle group was 68.0% (17 / 25), which was significantly higher than that in body gastric fundus group (9.5%) (2 / 21, P0.05). Gastric peristalsis score of gastric antrum angle group was also significantly higher than that of body gastric fundus group (P0.01). In terms of operation score, the incidence of affecting operation in antral horn group was 68.0% (17 / 25), which was significantly higher than that in body gastric fundus group (4.8%) and esophagus / stomach junction group (3.3% (1 / 30), P < 0.01). (P < 0.05); The operation score of gastric antrum and gastric horn group was also significantly higher than that of body gastric fundus group, esophageal and gastroesophageal junction group (P < 0.01). The peristalsis of patients with severe peristalsis was significantly inhibited after administration of racemic anisodamine (operation score 鈮，
本文编号：2432977
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