肺气肿手术的麻醉(7)

http://www.100md.com 2003年9月26日 好医生

     * PH70 mmHg以面罩CPAP(持续呼吸道正压)支持呼吸；

    第十一节 术后镇痛

    一、 胸腔镜手术

    * 手术结束时，0.5%布比卡因+1:20万肾上腺素做肋间神经阻滞；

    * 或小剂量吗啡(2-4 mg)静脉注入；

    * 或口服镇痛药；

    二、 开胸手术

    * PCEA(病人硬膜外自控镇痛)：0.2%布比卡因、4 ml/输注+2 ml/20 min 自控，发生低血压时，给与升压药支持。

    参考文献：

    1. Szekely LA, Oelberg DA, Wright C, et al. Preoperative predictors of operative morbidity and mortality in COPD patients undergoing bilateral lung volume reduction surgery. Chest. 1997 Mar; 111(3): 550-8

    2. Wisser W, Klepetko W, Senbaklavaci O, et al. Chronic hypercapnia should not be excluded from lung volume reduction surgery. Eur J Cardiothorac Surg 1998;14:107-112

    3. O'Brien GM, Furukawa S, Kuzma AM, et al. Improvements in lung function, exercise, and quality of life in hypercapnic COPD patients after lung volume reduction surgery. Chest 1999;155:75-84

    4. Keller CA, Naunheim KS, Perioperative management of lung volume reduction patients. Clin Chest Med 1997; 18(2): 285-300

    5. Tschernko EM, Wisser W, Hofer S, et al. The influence of lung volume reduction surgery on ventilatory mechanics in patients suffering from severe chronic obstructive pulmonary disease. Anesth & Analg 1996 83(5): 996-1001(许幸)

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