颅底外科手术麻醉及围术期处理86例.doc

颅底外科手术麻醉及围术期处理86例
作者:陈绍洋,王强,熊利泽,胡胜,李树志,张英民,曾毅
【关键词】,颅底/外科学
【Abstract】 AIM: The characteristics of perioperative treatment and anesthesia for skull base surgery in 86 patients were summarized. METHODS: According to preoperative general conditions of patients, nasogastric tube feed and intravenous hyperalimentation (n=21), tracheotomy (n=13) or cardiovascular drugs therapy (n=46) were implemented. Patients were divided into 4 categories by clinical manifestations such as with or without intracranial pressure elevation and tendency to mass bleeding and anesthesia bined intravenous and inspired anesthesia, controlled hypotension, moderate hyperventilation, autogenous hemodilution or mild hypothermia were carried out accordingly. RESULTS: The average time of operation was 219 min (125~810 min ). Hypotension (n=11) and arrhythmia (n=38) occurred during operation. Seventyone patients were well conscious within 10 min after operation. Tracheal intubation remained more than 12 h in three patients and respiration was supported by mechanical ventilation in ten patients after operation. Seventyone cases had good recovery without plications and five cases died. CONCLUSION: Great attention should be paid
to the preoperative preparation, individualoriented administration of anesthesia, integrated management during the operation and prevention of plications in skull base surgery.
【Keywords】 skull base/surgery; anesthesia; perioperative; management
【摘要】目的: 总结86例颅底手术患者的麻醉及围术期处理的特殊性. 方法: 依术前病情,予胃管鼻饲、静脉内高营养(21例)、行气管切开术(13例)和心血管系统药物治疗(46例),根据有无颅内压增高和大出血倾向等临床表现,将患者分为四类,针对各类患者病情特点,采取静吸复合全身麻醉,控制性降压,适度过度通气,自身血液稀释以及浅低温等. 结果: 手术时间平均219 (125~810) min,术中出现低血压11例,心律不齐38例,71例术毕10 min内苏醒,10例术后继续机械呼吸支持,3例留置气管导管12 h以上,71例愈后良好,5例死亡,无麻醉并发症. 结论: 此类患者手术麻醉应重视术前准备,实施计划麻醉,加强术中综合管理和术后并发症预防.

【关键词】颅底/外科学;麻醉;围术期;管理
0引言
现代颅底外科手术,使以往难以切除的肿瘤或不能一期手术的肿瘤,有可能得以一次性完全切除. 但由于颅底区有重要的血管、神经,肿瘤或畸形则可引起相应功能区的损害;手术操作又可因刺激、压迫或损伤该部位的重要神经、血管,而产生严重不良后果,甚至危及生命[1-3]. 因此颅底手术麻醉和围术期管理有其特殊性,我们将总结报告我院近年实施的病变侵及范围广、