巨大口咽癌行口、舌、咽颌面颈联合扩大根治术的麻醉处理:8例分析

Anesthetic management of 8 cases with combined extensive oro-glossal-pharyngeal-maxillofacial-cervical resection for oropharyngeal carcinoma

目的:回顾分析8例巨大口咽癌行口、舌、咽颌面颈根治并同期修复手术的麻醉处理。方法:选择恰当的麻醉方法和用药,进行麻醉诱导和维持。围术期监测血压、心率、血氧饱和度、中心静脉压、尿量、呼气末CO2分压、血红蛋白和颅内压及红细胞压积等;控制性降压结合急性单纯血液稀释,减少出血和输血;维持循环功能稳定,并减少血液粘滞度。术毕待血压、心率、中心静脉压、血氧饱和度、呼气末CO2分压、体温正常后入复苏室。结果:本组病例麻醉和手术经过良好,手术中出血量减少35%以上,术中患者的呼吸循环及其他重要器官功能维持良好。结论:控制性降压结合急性单纯血液稀释,能有效减少术中出血。重视围术期患者的监测处理,保证呼吸循环及其他重要器官功能处于良好状态,是麻醉成功的关键。

PURPOSE:To analyze the anesthetic management of 8 oropharyngeal carcinoma patients who underwent extensive oro-glossal-pharyngeal-maxillofacial-cervical resection and simultaneous reconstruction. METHODS: Suitable anesthetic methods and medication were chosen for induction and maintenance of anesthesia. Perioperative blood pressure, SpO2, rate of heart beat, central venous pressure (CVP), urine capacity, PETCO2, hemoglobin, hematocrit, intracranial pressure were monitored and quick hemodilution was used to decrease blood loss and blood transfusion, as well as maintain stable circulation and decrease blood adhesion. After operation, the patients were shifted to the postanesthetic recovery room when the BP, CVP, SpO2, PETCO2,urine capacity, temperature were normal and stable. RESULTS: The anesthesia and surgery was uneventfull in this series. Intraoperative bleeding was significantly decreased by more than 35% and the respiration and circulation was well maintained. CONCLUION: Controlled hypotension combined with quick hemodilution reduced intraoperative bleeding and the operation could be tolerated by the indicated patients. Careful intraoperative monitoring and management of the patients, stable respiration and circulation, and other important organs functioning well are the key factors for successful operation.