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          烟台毓璜顶医院中区麻醉科为一例重度肺心病患者成功实行手术麻醉

          来源:烟台毓璜顶医院编辑:姜涛发布日期:2019-08-07 14:08:00

          通讯员:李成修、李凌峰

          近日,烟台毓璜顶医院中区麻醉科为一例重度肺心病患者成功实行胃癌根治术手术麻醉,患者出院后,特地打来电话向麻醉师表示感谢。

          患者76岁,身体状态很差,以往患有双肺肺气肿、肺大泡并右肺中叶肺不张,多年慢性阻塞性肺疾病并有严重的肺源性心脏病。最近因胃部不适来烟台毓璜顶医院普外儿外科就诊,被诊断为胃癌合并出血。患者年龄大,心肺功能极差,重度贫血,常规来说,麻醉术中极有可能发生猝死风险,术后气管插管拔管困难,长期带管更是对原本脆弱的心肺功能以致命打击。这给麻醉医生围术期管理带来了极大的挑战。

          近年来,烟台毓璜顶医院将加速康复外科(ERAS)作为新的治疗理念和康复模式,在全省率先全面开展了ERAS手术。而麻醉围术期管理与镇痛则是患者术后快速康复和转归的关键因素。该患者的麻醉方案由中区麻醉科马加海主任与郑世建主任医师共同制定,采用高位硬膜外麻醉复合喉罩置入浅全麻方法,为患者提供了完善的术中及术后镇痛,减少了全麻用药和手术应激刺激,加快了患者快速苏醒和肺功能恢复。此外,浅全麻既消除了病人的焦虑紧张,又便于术中的呼吸循环管理。

          手术由普儿外科吕忠船副主任主刀,手术顺利,术中生命体征稳定,缝皮前切口局部浸润麻醉。手术结束后,即刻为患者拔除喉罩,患者自主呼吸良好,意识恢复迅速,避免了病人术后持续带管导致肺炎、机械通气肺损伤等问题。术后第二天随访,患者VAS镇痛评分1分,可下床活动。目前病人已康复出院,患者出院前,家属特意给麻醉科打来电话表示感谢。

          可见,ERAS对提高治疗效果、加速病人康复、减少术后并发症,实现医院、患者、医保“三赢”具有重要意义,而麻醉方式与麻醉质量的管理更是对病人愈后转归起到了关键作用。

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