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巨大盆腹腔肿瘤切除术的麻醉管理 附86例病例分析 |
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杨萍 杨文芳 孙莉 刘雄华
摘 要：目的 分析总结86例妇科巨大盆腹腔肿瘤患者的麻醉管理，显示患者并发症。呼吸及循环方面发生的一系列病理生理变化。方法 采用持续硬膜外麻醉40例，用药为地卡因+利多卡因。采用全身吸入麻醉46例，用药为硫贲妥钠或异丙酚+琥珀胆碱或卡肌宁快速诱导气管内插管，吸入氨氟醚加潘可罗宁或卡肌宁维持麻醉。结果 硬膜外麻醉组血压和心率波动发生率显著高于全麻醉组。结论 麻醉方法以全麻为宜，术中应预防误吸，仰卧位低血压综合征等，加强呼吸和循环管理，重点防止因腹压骤降所引起的循环波动。
关键词：巨大盆腹腔肿瘤 麻醉管理
Anesthesia management of operation on huge abdomenal and pelvic tumor
(the anglysis of 86 cases)
Yang Ping
(Department of Anesthesia Cancer Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100021)
Yang Wenfang
(Department of Anesthesia Cancer Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100021)
Sun Li
(Department of Anesthesia Cancer Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100021)
Abstract：This report analysed and summarized the experiences of anesthesia management of resection on huge abdomenal and pelvic tumor in 86 cases in gynecology. These patients suffered from various complications, and their respiratory and circulatory systems have been damaged in defferent degrees. To improve the toleration for anesthesia, the preoperative preparation must be done carefully. Compared with the incidence of fluctuation of blood pressure and heart rate, the epidural anesthesia group is obviously higher than that of the general anesthesia, this showed that general anesthesia should be the first choice. During opeartion, monitoring are managing for the function of respiratory and circulatory is very important. Speical attention should be paid to prevention of inspiratory regurgitation, supine hopotension syndrome, and cyclic fluctuation caused by sudden reduced abdomenal pressure.
Key words：Abdomenal and pelvic tumor Anesthesia management▲
巨大盆腹腔肿瘤患者因腹部高度膨隆，内脏器管受压移位，由此产生循环呼吸的病理生理改变，全身情况差，并发症多，承受手术和麻醉的能力低，麻醉处理不当，直接危及生命安全。本文分析总结了本院1982～1998年妇科巨大盆腹腔肿瘤切除术的麻醉管理共86例，报告如下。
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