嗜铬细胞瘤手术麻醉方法的探讨

A study on the methods of anesthesia in surgery of pheochromocytoma

目的探讨嗜铬细胞瘤手术中血流动力学改变和麻醉与管理。方法 19例患者均采用全麻,以咪唑安定、丙泊酚、芬太尼和维库溴铵等全麻。麻醉维持吸入异氟醚、N2O+O2及输注丙泊酚。当收缩压超过20 kPa时用硝普钠、酚妥拉明降压。当收缩压低于12KPa时用去甲肾上腺素升压。建立完善的血液动力学监测。结果所有患者均安全顺利完成麻醉和手术。14例采用硝普钠0．2～8．0(2．3±1．2)μg·kg-1·min-1降压,控制收缩压在 16 kPa左右。1例加用酚妥拉明2mg分次静注血压降至目标水平。11例采用去甲肾上腺素0．01～0．15(0．05± 0．02)μg·kg-1·min-1升压,维持收缩压在14～16 kPa左右。结论麻醉药多种复合应用,麻醉适当偏深,完善的监测以及根据血液动力学实施的降压和升压措施,是保证手术成功和患者安全的关键。

Objective： To study the hemodynamic changes as well as anesthesia and management of pheochrornocytoma surgery. Methods： General anesthesia was applied to all of the 19 patients with imidazole diazepam, propofol, fentanyl and vecuronium, isoflurane and N2O＋ O2 were inhaled and propofol was transfused to maintain anesthesia. Sodium nitroprusside and phentolamine were used to lower pressure when systolic pressure was higher than 20 kPa. And noradrenalin was used to raise pressure when systolic pressure was lower than 12 kPa. Complete hemodynamic monitoring was set up. Results ：Both anesthesia and surgery went smoothly for all the patients. Sodium nitroprusside （0.2-8.0〈 2.3±1.2）μg·kg^-1·min^-1）was applied to 14 cases to decrease systolic pressure to about 16 kpa. The blood pressure of one patient decreased to target level with addition of fractional intravenous injection of 2 mg of phentolamine. Noradrenalin （0. 01 -0.15 〈 0.05± 0.02 〉μg·kg^-1·min^-1） was used on 11 cases to increase pressure and maintain systolic pressure around 14- 16 kPa. Conclusion ： Combined application of anesthetics usually causes deep anesthesia. Complete monitoring and measures to lower and raise blood pressure according to hemodynamics are critical for successful surgery and patient safety.