合并肢端肥大症的垂体腺瘤患者麻醉管理及并发症

Anesthetic management and complications in pituitary adenoma patients with acromegaly

目的 探讨合并肢端肥大症对垂体腺瘤合并肢端肥大症患者的麻醉管理及并发症的发生是否有影响 .方法 选在全麻下行经蝶窦或开颅垂体腺瘤切除术合并有肢端肥大症患者 12 0例 ,另选 36例年龄、体质量和性别相似的非肢端肥大症同类手术患者行比较研究 ,探讨合并肢端肥大症对麻醉诱导时面罩通气、气管插管困难和危险性 ,血流动力学及其他麻醉并发症的影响 .结果 合并肢端肥大症患者面罩通气泄漏率 ,舌根肥大 ,上呼吸道梗阻 ,血氧饱和度 (Sp O2 )≤ 90 %发生率 ,困难插管评分 (IDS)均明显高于对照组 (P<0 .0 1) ,糖尿病、高血压、心肌缺血的发病率以及血压 (BP)波动幅度均高于对照组 (P<0 .0 1) ,血糖明显升高 ,p H值降低 .芬太尼、异丙酚、尼卡地平、艾司洛尔的用量亦明显大于对照组 (P<0 .0 5 ) ,心率 (HR)改变 ,万可松用量 ,术中液体入量 ,Fi O2 ,Pa O2 以及 Pa CO2 均相似 .尿量较对照组为少 (P<0 .0 5 ) .结论 合并肢端肥大症患者易发生呼吸道梗阻 ,面罩通气和气管插管困难 ,有显著的血流动力学改变 ,血糖。

AIM To investigate the changes in the clinical features of anesthetic management, safety and the incidenceof major complications in acromegaly patients. METHODS 120 patients of pituitary tumour with acromegaly, and another 36 non acromegalic patient undergoing transsphenoidal or craniotomy pituitectomy were studied. The difficulties of mask ventilation, intubation difficulties and risks, the changes in hemodymamics and other anesthetic complications were evaluated. RESULTS Difficulty airway, important gas flow leak from the face mask, tongue enlargement and blood oxyen saturation (SpO 2)≤90% were encountered more often and the intubation difficulty scale (IDS) was higher in the acromegalic patients than in the non acromegalic patients. Acromegalic patients needed significantly more fentenyl, propofol, nicardipine and esmolol than the control patients (all P <0.05). The values of baseline mimimum and maximam were higher in the acromegalic patients than those in the controls. There was no difference between the two groups in the use of vasoactive drugs. FiO 2, PaO 2, PaCO 2, SpO 2 EtCO 2 and dose of vencronium were similar in both groups. Arterial pH was significantly lower ( P <0.05), blood glucose was higher ( P <0.01) and urinary output was lower ( P < 0.05 ) in the acromegalic patients than in the control patients. Severe haemodynamic instability did not occur during surgery for the acromegaly patients. CONCLUSION Airway difficulties occurred more freguently, and, IDS, glucose and blood pressure were more higher in the arromegalic patients than in the controls. Anesthetic complications occurred more often and introperaty morbidities were higher in the aeromegalic patients than in the control patients.