高强度聚焦超声治疗肝癌的麻醉探讨

Anesthetic management during high intensity focused ultrasound for liver cancer

目的探讨高强度聚焦超声（high intensity focused ultrasound，HIFU）治疗肝癌病人的麻醉特点。方法21例全部采用静吸复合全麻，丙泊酚、咪达唑仑、芬太尼和维库溴铵静脉注射诱导，气管内插管行控制呼吸，持续吸入异氟烷或恩氟烷，间隙追加芬太尼、丙泊酚和维库溴铵，保持术中病人良好的肌松和完善的镇痛，维持病人血流动力学和体温的稳定。结果21例均在全麻下成功完成HIFU治疗，2例HIFU治疗时须加深麻醉抑制焦点区刺激反应。手术时间245～423min，（329±48）min；术毕苏醒时间7～18min，（11±3）min；拔除气管导管时间9～24min，（15±4）min。1例术后并发少量胸腔积液，2周后自行消失。结论静吸复合全麻是高强度聚焦超声治疗肝癌病人安全有效的麻醉方法。

Objective To explore the anesthetic management during high intensity focused ultrasound （HIFU） for liver cancer. Methods A total of 21 patients underwent combined intravenous and inhaled general anesthesia. The anesthesia was induced by the administration of propofol, midazolam, fentanyl, and vecuronium. Endotracheal intuhation was performed for mechanical ventilation. The anesthesia was maintained with inhalation of isoflurane or enflurane combined with additional administration of fentanyl, propofol, and vecuronium. Optimal analgesia and muscular relaxation condition were maintained and the hemodynamic parameters and body temperature were kept stable during the operation. Results All the 21 patients were successfully treated with HIFU under general anesthesia. A deepen anesthesia was required to depress stimulus responses while HIFU treatment in 2 patients. The duration of operation was 245～423 min （329±48 min）, the time to recovery from the anesthesia was 7～18 min （11±3 min）, and the time to extubation was 9～24 min （15±4 rain）. A small amount of pleural effusion was observed after operation in 1 patient and spontaneously disappeared after 2 weeks. Conclusions Combined intravenous and inhaled general anesthesia is a safe and effective anesthetic method for HIFU treatment for liver cancer.