协和医学杂志

2012, (04)

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经皮内窥镜引导下胃造口术的麻醉
Anesthetic Management during Percutaneous Endoscopic Gastrostomy

黄宇光;康维明;罗爱伦;马志强;徐建青;于健春

摘要(Abstract):

目的:探讨经皮内窥镜引导下胃造口术(percutaneous endoscopic gastrostomy, PEG)的临床麻醉经验。方法:回顾性分析北京协和医院90例PEG患者的临床资料,并对麻醉方式、静脉麻醉药物和麻醉风险进行总结。结果:85例采用表面麻醉+局部麻醉+静脉镇静或全麻,其中仅1例采用气管插管全麻;其他5例采用表面麻醉+局部麻醉。静脉麻醉药物主要为咪达唑仑、芬太尼或舒芬太尼、丙泊酚或依托咪酯,用药剂量和方法各不相同。在PEG过程中患者血流动力学和呼吸基本平稳,但可能发生低氧血症、高血压和心动过缓等风险。与PEG前比较,PEG期间收缩压、舒张压和心率最小值明显下降,脉搏血氧饱和度最大值明显上升,差异有统计学意义(P<0.05)。结论:PEG的麻醉方式可以采用表面麻醉+局部麻醉+静脉镇静或全麻,但应加强麻醉管理。
Objective To explore clinical experience in anesthetic management of percutaneous endoscopic gastrostomy (PEG). Methods Clinical data of 90 patients with PEG were analyzed retrospectively. Anesthetic methods, intravenous anesthetic drugs and anesthetic risks were summarized. Results There were 85 cases with topical anesthesia + local anesthesia + intravenous sedation or general anesthesia, of which only one case with endotracheal intubation under general anesthesia while five cases with topical anesthesia + local anesthesia. Intravenous anesthetic drugs included mainly midazolam, fentanyl or sufentanil, propofol or etomidate with different medication dosage and method. Although the hemodynamic and respiratory changes were basically stable during PEG, the risk such as hypoxemia, hypertention and bradycardia occurred occasionally. Conclusion PEG can be carried on under topical anesthesia + local anesthesia + intravenous sedation or general anesthesia, but anesthetic management should be strengthened.

关键词(KeyWords): |经皮内窥镜引导下胃造口术|麻醉|
|percutaneous endoscopic gastrostomy| anesthesia|

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作者(Author): 黄宇光;康维明;罗爱伦;马志强;徐建青;于健春

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