晚期肿瘤患者全身热疗围麻醉期的液体管理

Fluid management during anesthesia of whole body hyperthermia to patient with late malignant tumor

目的总结晚期肿瘤患者全身热疗围麻醉期的液体管理特点。方法100例晚期肿瘤患者,全麻后采用ET-Speac远红外线辐射仓进行全身热疗,常规监测ECG、SpO2、PETCO2、IBP、CVP、动脉血气及血糖。在体温升至39℃之前为扩容阶段,补充治疗前体液累计缺失量和CVE;之后为维持阶段,补充治疗中继续损失量和生理需要量。输液晶体胶体比例为2、3∶1,适量给予果糖和高渗糖液。结果100例患者治疗中平均输液(5231±1005)mL,尿量(1734±563)mL;术中并发症:心衰13例,间质性肺水肿2例,低血压21例,中心静脉压升高41例,心率增快100例。结论为防治围麻醉期心衰、肺水肿等严重并发症,提出扩容阶段+维持阶段的液体管理方案。并提倡扩容阶段延长时间,充分扩容;维持阶段液体负平衡的原则。

[Objective] To investigate the character of fluid management during anesthesia of Whole Body hyperthermia to the patient with late malignant tumor. [Method] 100 patients who suffered malignant tumor were investigated, after general anesthesia, Whole Body hyperthermia was performed with ET-Speac far infrared radiation space, Electrocardiograph （ECG）, SpO2,PETCO2, invasive blood pressure （IBP）, central venous pressure （CVP）, artral blood gas, blood sugar were monitored. The period before the body temperature rise to 39℃ was defined as expand volume stage, CVE and accumulative total lost volune were infused; and the period after, maintain stage, which physiology require volume and continue lost volume were infused. Crystalloid and colloid were infused in proportion of 2, 3：1, suitable amount of fructose and 25% glucose were infused. [Result] The mean infused volume of 100 patient was （5 231±1 005） mL, mean urine volume （1 734±563） mL. Complications during the treatment： heart failure was found in 13 patients, 2 patients suffered interstitial pneumonia, 21 patients with hypotension, 41 patients have a rise in CVP, and all 100 patients have tachycardia. [Conclusion] To prevent severe complications such as heart failure and pulmonary edema during perianesthesia, we design the fluid management procedure which including expand volume stage and maintain stage, during expand volume stage, we advocate a much long time and expand volume sufficiently; while the maintain stage, a negative-balanced fluid management was recommend.