非气管插管静脉全麻在胸腔循环热灌注治疗中的应用

Applications of Non Intubation Intravenous Anesthesia During Circle Intrapleural Hyperthermic Perfusion

目的探讨非气管插管静脉全麻在胸腔循环热灌注中应用的可行性及安全性。方法拟行胸腔循环热灌注术患者20例,均经病理活检已确诊为肺部恶性肿瘤。建立生命体征及BIS监测后,鼻导管吸氧,局麻行右颈内静脉及桡动脉穿刺置管。予丙泊酚及瑞芬太尼TCI静脉诱导及维持麻醉,观察记录麻醉前、术中、术毕及术后30min各时段的HR、MAP、RR、SpO2、CVP、心电图ST-T、体温T及抽取动脉血作血气分析。结果所有患者均能在非气管插管静脉全麻下完成治疗,术中BIS值监测维持于45~60,无一例发生术中知晓。HR、MAP、SpO2及心电图ST-T各时段比较差异无统计学意义（P〉0.05）,术中较术前呼吸频率减慢,CVP及体温升高,PCO2升高,pH值下降（P〈0.05）,但均在术后30min内恢复至术前水平。结论非气管插管静脉全麻在胸腔循环热灌注中的应用是可行的,术中应加强呼吸循环功能监测,确保麻醉安全。

Objective To investigate the feasibility and security of non intubation intravenous anesthesia during circle intrapleural hyperthermic perfusion. Methods Diagnosed with lung cancer in biopsy, 20 cases scheduled to receive circle intrapleural hyperthermic perfusion were studied. After the establishment of life signs,BIS monitoring, right internal jugular vein and radial artery puncture,Anesthesia was induced and maintained with intravenous Propofol and remifentanil by TCI.Variables of each time interval before anesthesia, during operation, post operation and 30 minutes after operation were recorded,including HR, MAP, RR, SpO2, CVP, ST-T ,T and arterial blood for blood gas analysis. Results All patients were completed treatment under non intubation intravenous anesthesia.Intraoperative monitoring of BIS maintained 45-60 and no intraoperative awareness happened. There were no significant differences in HR, MAP, SpO2 and ST-T of each time interval（P〈0.05）. Compared with the time interval before anesthesia,intraoperative respiratory rate slowed, CVP and temperature elevated, PCO2 elevated and pH value decreased（P〈0.05）, but all were recovered after 30 minutes. Conclusion Non intubation intravenous anesthesia in circle intrapleural hyperthermic perfusio is feasible.Intraoperative monitoring should be strengthened to ensure the safety of respiratory and circulatory system in anesthesia.