Kamata Mineto, Cartabuke Richard S, Tobias Joseph D
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
Paediatr Anaesth. 2015 Dec;25(12):1193-206. doi: 10.1111/pan.12792. Epub 2015 Oct 22.
Pyloric stenosis (PS) is one of the most common surgical conditions affecting neonates and young infants. The definitive treatment for PS is surgical pyloromyotomy, either open or laparoscopic. However, surgical intervention should never be considered urgent or emergent. More importantly, emergent medical intervention may be required to correct intravascular volume depletion and electrolyte disturbances. Given advancements in surgical and perioperative care, morbidity and mortality from PS should be limited. However, either may occur related to poor preoperative resuscitation, anesthetic management difficulties, or postoperative complications. The following manuscript reviews the current evidence-based medicine regarding the perioperative care of infants with PS with focus on the preoperative assessment and correction of metabolic abnormalities, intraoperative care including airway management (particularly debate related to rapid sequence intubation), maintenance anesthetic techniques, and techniques for postoperative pain management. Additionally, reports of applications of regional anesthesia for either postoperative pain control or as an alternative to general anesthesia are discussed. Management recommendations are provided whenever possible.
幽门狭窄（PS）是影响新生儿和婴幼儿的最常见外科疾病之一。PS的确定性治疗方法是外科幽门肌切开术，可采用开放手术或腹腔镜手术。然而，手术干预绝不应被视为紧急或急症情况。更重要的是，可能需要进行紧急医疗干预以纠正血管内容量耗竭和电解质紊乱。鉴于外科手术和围手术期护理的进展，PS导致的发病率和死亡率应受到限制。然而，发病率和死亡率可能因术前复苏不佳、麻醉管理困难或术后并发症而发生。以下手稿回顾了关于PS患儿围手术期护理的当前循证医学，重点关注术前评估和代谢异常的纠正、术中护理，包括气道管理（特别是与快速顺序插管相关的争议）、维持麻醉技术以及术后疼痛管理技术。此外，还讨论了区域麻醉用于术后疼痛控制或作为全身麻醉替代方法的应用报告。尽可能提供管理建议。
