腹腔镜消化道手术中麻醉策略的创新与进展

Innovation and Progress of Anesthesia Strategies in Laparoscopic Gastrointestinal Surgery

摘要: 腹腔镜消化道手术(Laparoscopic gastrointestinal surgery, LGS)在现代外科应用渐广，其创伤小、恢复快、住院短等优势突出。不过，二氧化碳气腹与特殊体位使患者呼吸、循环、神经内分泌等系统受复杂影响，给麻醉管理带来严峻挑战。本文深入探究该手术麻醉策略创新进展。联合麻醉技术成效显著，全凭静脉麻醉与超声引导神经阻滞联用，借静脉麻醉特性与神经阻滞精准定位，减药用量、并发症，强镇痛与康复；改良快速顺序诱导法优化药物、剂量、顺序，结合高效预氧合与气道管理，提升麻醉诱导安全性与手术质量；目标导向液体治疗与预防性多模式镇痛协同，精准控液、多机制镇痛，避免液体失衡、减痛并促康复，彰显围术期综合管理优势。麻醉药物选择应用有进展，短效静脉麻醉药丙泊酚与雷米芬太尼、吸入麻醉药七氟烷与地氟烷、肌松药罗库溴铵与顺式阿曲库铵各有特性与适用情境。麻醉监测技术发展助力手术，超声用于神经阻滞定位与血流动力学监测，TEE和超声引导血管穿刺置管可实时掌控心脏血管状态；脑电监测的BIS和熵指数监测能精准反映麻醉深度与镇痛程度，保障麻醉安全精确。还阐述手术各阶段麻醉管理要点，术前全面评估与准备，术中精细管理，术后科学管控。为腹腔镜消化道手术麻醉提供系统理论与实践指导，推动麻醉技术发展完善，提升麻醉质量与手术预后。

Abstract: Laparoscopic gastrointestinal surgery (LGS) is increasingly used in modern surgery, with outstanding advantages such as less trauma, faster recovery, and shorter hospital stays. However, carbon dioxide pneumoperitoneum and special body positions affect the patient’s respiratory, circulatory, neuroendocrine and other systems in a complex manner, bringing severe challenges to anesthesia management. This article deeply explores the innovative progress of anesthesia strategies for this surgery. Combined anesthesia technology has achieved remarkable results. Total intravenous anesthesia is combined with an ultrasound-guided nerve block. It uses the characteristics of intravenous anesthesia and precise positioning of a nerve block to reduce drug dosage and complications, and enhance analgesia and rehabilitation; the improved rapid sequence induction method optimizes drugs, doses, and sequences, and combines efficient preoxygenation and airway management to improve the safety of anesthesia induction and surgical quality; goal-oriented fluid therapy and preventive multimodal analgesia work together, accurately control fluids, and provide multi-mechanism analgesia, avoid fluid imbalance, reduce pain, and promote rehabilitation, highlighting the advantages of comprehensive perioperative management. There has been progress in the selection and application of anesthetic drugs. Short-acting intravenous anesthetics propofol and remifentanil, inhaled anesthetics sevoflurane and desflurane, and muscle relaxants rocuronium and cisatracurium each have their own characteristics and applicable scenarios. The development of anesthesia monitoring technology has helped surgery. Ultrasound is used for nerve block positioning and hemodynamic monitoring. TEE and ultrasound-guided vascular puncture and catheterization can monitor the state of the heart and blood vessels in real time. BIS and entropy index monitoring of EEG monitoring can accurately reflect the depth of anesthesia and the degree of analgesia, ensuring safe and accurate anesthesia. It also explains the key points of anesthesia management at each stage of surgery, comprehensive preoperative evaluation and preparation, meticulous intraoperative management, and scientific postoperative control. It provides systematic theoretical and practical guidance for anesthesia in laparoscopic gastrointestinal surgery, promotes the development and improvement of anesthesia technology, and improves anesthesia quality and surgical prognosis.