CAJ | 학술논문

目的探讨胃食管反流病(GERD)胃底折叠术中支气管痉挛的发生与处理措施.方法总结GERD胃底折叠术中发生支气管痉挛的34例资料.结果 34例中剖腹手术6例,腹腔镜手术28例.支气管痉挛有8例在气管插管后即刻发生,10例在气管插管后1～10 min手术开始前发生,14例在术中不同时间不明原因发生,1例在术后气管拔管送回监护病房后发生,1例气管插管后的顽固支气管痉挛未行手术.处理措施均为静注糖皮质激素和氨茶碱,吸入七氟醚,呼吸机正压通气.以上措施无效者加用肾上腺素.结论 GERD胃底折叠术患者多有支气管痉挛的呼吸道症状,为麻醉的危险凶素之一,麻醉医师应高度重视,妥善处理.
목적 탐토위식관반류병(GERD)위저절첩술중지기관경련적발생여처리조시.방법 총결GERD위저절첩술중발생지기관경련적34례자료.결과 34례중부복수술6례,복강경수술28례.지기관경련유8례재기관삽관후즉각발생,10례재기관삽관후1～10 min수술개시전발생,14례재술중불동시간불명원인발생,1례재술후기관발관송회감호병방후발생,1례기관삽관후적완고지기관경련미행수술.처리조시균위정주당피질격소화안다감,흡입칠불미,호흡궤정압통기.이상조시무효자가용신상선소.결론 GERD위저절첩술환자다유지기관경련적호흡도증상,위마취적위험흉소지일,마취의사응고도중시,타선처리.
Objective To explore the countermeasure of bronchospasm attack in 34 cases undergoing fundoplication of gastroesophageal reflux disease(GERD).Methods Data of 34 cases with bronchospasm attack undergoing fundoplication of GERD were reviewed retrospectively.Results Of 34 cases,bronchospasm attack took place in 6 cases of laparotomic fundoplication and 28 cases of laparoscopic fundoplication.Bronchospasm happened immediately after intubation in 8 cases,within 1 to 10 min after intubation in 10 cases,during the operation in 14 cases,on the way to ICU after extubation in 1 case.1 cases of severe bronchospasm attack could not be controlled after intubation and could not be operation.All cases were treated with intravenous glucocorticoids and aminophylline,sevoflurane inhalation,mechanical ventilation with high positive end -expiratory pressure(PEEP).The patient of severe bronchospasm attack could not be controlled add using epinephrine.Conclusion Most patients with GERD menefested bronchospasm,which is one of the risk factors for anesthesia,and should be paid attention to.