Parthasarathy S, Sripriya R, Krishnaveni N
Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India.
Anesth Essays Res. 2016 Sep-Dec;10(3):397-401. doi: 10.4103/0259-1162.177192.
Intestinal obstruction is associated with significant morbidity and mortality. Scientific assessment of the cause, site of obstruction, appropriate correction of the fluid deficit and electrolyte imbalance with preoperative stabilization of blood gases is ideal as a preoperative workup. Placement of a preoperative epidural catheter especially in the thoracic interspace takes care of perioperative pain and stress reduction. Intraoperative management by controlled general anesthesia administering a relative high inspired fraction of oxygen with invasive monitoring in selected sick cases is mandatory. Preoperative monitoring and stabilizing raised intra-abdominal pressure reduces morbidity. Caution should be exercised during opening and closure of abdomen to avoid cardiorespiratory ill effects. There should be an emphasis on avoiding hypothermia. The use of nonsteroidal anti-inflammatory drugs may worsen sick, fragile patients. The use of sugammadex rather than neostigmine will obscure certain controversies in the healing of intestinal anastomotic site. Replacement of blood loss continued correction of fluids and electrolytes with possible postoperative mechanical ventilation in sick cases may improve outcomes in these patients.
肠梗阻与显著的发病率和死亡率相关。对病因、梗阻部位进行科学评估，通过术前稳定血气来适当纠正液体不足和电解质失衡，作为术前检查是理想的。放置术前硬膜外导管，尤其是在胸段间隙，可处理围手术期疼痛并减轻应激。对于部分病情较重的病例，术中采用控制全身麻醉，给予相对高的吸入氧分数并进行有创监测是必要的。术前监测并稳定升高的腹内压可降低发病率。在腹部切开和缝合过程中应谨慎操作，以避免对心肺产生不良影响。应强调避免体温过低。使用非甾体类抗炎药可能会使病情严重、身体虚弱的患者情况恶化。使用 sugammadex 而非新斯的明将消除肠道吻合口愈合方面的某些争议。在病情较重的病例中，补充失血、持续纠正液体和电解质，并可能进行术后机械通气，可能会改善这些患者的预后。
