经口内镜下环形肌切开术11例麻醉体会

Anesthesia experience of 11 cases of POEM operation cases

摘要:

目的 探讨气管插管全身麻醉（全麻）在经口内镜下环行肌切开术（POEM）中应用的安全性和可行性。方法 回顾分析该院2012年7月～2013年5月11例应用气管插管全麻下行POEM术的患者，常规持续监测并定时记录患者在POEM术中的心率、血压及血氧饱和度的变化；术中的不良反应（如体动、呛咳、反流、误吸、皮下气肿、气胸及气腹等情况）；术后患者对术中的记忆和疼痛的感觉以及恶心呕吐等不良反应。结果 11例气管插管全麻下行POEM术的患者全部成功，11例麻醉效果全部满意，1例患者POEM术中食管下段全层肌肉切开，操作时间长，导致充入二氧化碳（CO2）过多出现皮下气肿、气胸或气腹。结论 气管插管全麻下行POEM术的患者的镇静、镇痛效果满意，不良反应少，能为患者提供安全、满意的POEM手术条件。

Abstract:

【Objective】 To discuss the safety and feasibility of general anesthesia with endotracheal intubation in the peroral endoscopic myotomy (POEM). 【Methods】11 patients who undergoing POEM operation under general anesthesia with endotracheal intubation were reviewed in our hospital during 2012 July to 2013 May. The changes of heart rate, blood pressure and oxygen saturation of blood were continuously monitored and timely recorded routinely, untoward effects during the operation, such as body movement, cough, regurgitation, aspiration, subcutaneous emphysema pneumothorax and pneumoperitoneum were also recorded faithfully. After operation, patients were followed up about the memory and pain feeling in the operation and also the adverse effects such as nausea and vomiting. 【Results】 All the 11 cases with tracheal intubation technique in POEM operation were successful, the anesthesia results were satisfactory. Only 1 patient turned up subcutaneous emphysema, pneumothorax and pneumoperitoneum because CO2 were filled in the esophageal dissection (submucosa) too much and fast. 【Conclusion】 Tracheal intubation technique in POEM operation is safe and effective in the POEM.