肿瘤术后全身热化疗病人深度镇静麻醉管理

Tumor Postoperative Systemic Thermo-chemotherapy Patients with Deep Sedation Anesthesia Management

目的:探讨肿瘤术后全身热化疗深度镇静麻醉的临床应用。方法:选择24例肿瘤术后病人,ASAⅡ～Ⅲ级,无心脑血管病变,在设定核心温度为40.0～41.8℃情况下,病人不能耐受高温,此时静脉注入咪达唑仑和静脉持续泵入丙泊酚维持,有创监测血液动力学,肺氧合指标,测电解质、血糖、尿量至降温期39.5℃以下,渐停镇静至清醒。结果:24例病人先后做了53次热化疗,升温期和恒温期、心率、中心静脉压增加,ACO2分压、血气、血钾、血糖下降,降温期恢复,在保持循环稳定的情况下,有10例病人术中使用β1受体阻滞剂,有6例病人术中舌下坠影响通气,需放置口咽通气道,有3例术后肘关节有轻微烫伤,无其他并发症出现。结论:深度镇静麻醉用于肿瘤术后全身热化疗,简便易行,操作方便,对病人生命体征干扰小,是一种安全有效、可行的静脉麻醉药。

Objective：To explore the clinical application of the tumor body heat after chemotherapy deep sedation anesthesia.Methods：24 cases of patients with tumor resection,ASAⅡ~Ⅲ grade,unintentional cerebral vascular disease,the set core temperature was 40.0~41.8℃,the patients can not tolerate high temperatures,the microphone up to the intravenous injection of alprazolam and intravenous continuous infusion of propofol to maintain invasive monitoring of hemodynamic,oxygenation index,measured electrolyte,blood glucose and urine to the cooling period 39.5℃ less grind to a halt sedative to sober.Results：24 patients has 53 thermo-chemotherapy,the warming period and the constant temperature period,heart rate,central venous pressure increase,ACO2 partial pressure,blood gas and serum potassium blood sugar drops,the cooling of recovery,to keep the loop stable case,10 cases of patients undergoing β1 receptor blocker,six cases of patients undergoing tongue falling affect ventilation,need to place the oropharyngeal airway,there are three cases suffering from postoperative elbow minor burns,no other complications.Conclusion：Deep sedation anesthesia for tumors of body heat after chemotherapy,simple,easy to operate,small signs of interference on the patients＇life is a safe and effective,feasible intravenous anesthetics.