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在阿喀拉西亚患者口腔内镜肌肉切除过程中对麻醉管理的评估:一项回顾性研究
Mukadder Sanli1, Sami Akbulut2,3, Muharrem Ucar1
1Department of Anesthesiology and Reanimation, Inonu University Faculty of Medicine, 44280 Malatya, Turkey.
Journal of clinical medicine
|September 27, 2025
概括
在阿喀拉西亚患者的口腔内镜肌切除术 (POEM) 中,麻醉管理是安全的,仔细监测可以预防严重的并发症. 这种微创手术在适当的术后护理下显示出良好的结果.
科学领域:
- 胃肠病学 胃肠病学
- 麻醉学 麻醉学
- 最少侵入性的手术
背景情况:
- 阿哈拉西亚是一种主要的食道机动性障碍,在麻醉期间存在挑战,原因是下食道 (LES) 放松受损,周围静脉缺失,增加了吸收风险.
- 门内镜肌切除术 (POEM) 是一种极少侵入性的治疗,需要专门的麻醉方案,以确保患者的安全.
研究的目的:
- 评估POEM手术期间的外科手术期间麻醉管理.
- 分析与POEM相关的通风参数,手术内血动力学,实验室变化和术后并发症.
主要方法:
- 在2016年6月至2025年4月期间接受POEM的51名患者的回顾性分析.
- 评估人口统计数据,麻醉技术 (包括快速序列诱导和德斯弗维护),手术内生理参数和血液学概况.
- 调整了通风设置,以限制潮尾二氧化碳 (ETCO2) 升高.
主要成果:
- 患者主要是ASA II/III,并患有高血压和糖尿病等并发症.
- 术内发现包括稳定的峰值吸气压,改善氧和 (SpO2),短暂的血压下降,并增加ETCO2 (平均49mmHg).
- 常见的早期并发症是皮下肺气 (19.6%),轻微出血 (9.8%) 和肺气 (7.84%);在 546 天的中位数随访期间没有报告死亡. 长期并发症如GERD (3.92%) 和食道炎 (1.96%) 是不常见的.
结论:
- 尽管CO2灌气过程中的生理变化,但POEM可以在量身定制的麻醉管理下安全地进行.
- 副作用通常是轻微的和自我限制的,强调了密切的手术内监测和跨学科合作的重要性,以获得有利的结果.
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