老年患者仰卧位行巨大前纵隔肿瘤切除术的麻醉管理1例

Anesthesia management in elderly patient with resection of a large anterior mediastinal tumor in the supine position:A case report

纵隔肿瘤又称纵隔肿块综合征,由于其生长位置的特殊性,一直以来都为手术麻醉管理带来挑战。特别是巨大纵隔肿瘤,常常累及心肺功能,稍有不慎后果不堪设想。此病例患者慢性起病,肿瘤巨大,位于前纵隔,以胸闷和吞咽困难为主要临床表现,已发展至大量心包积液、平卧位右肺动脉闭塞、压迫气道>50%、肺不张。采用术前减容、清醒气管插管等方式尽量减少心肺压力,该手段为肿瘤切除的全身麻醉管理提供益处,并于术后积极预防复张性肺水肿等,最终完成了较为平稳安全的围手术期管理,患者治愈出院。总结该病例经验,以期为纵隔肿瘤围手术期管理提供参考。

Mediastinal tumor,also known as mediastinal mass syndrome has long been an anesthetic challenge due to its unique growth location.In particular,a large mediastinal tumor often involves cardiopulmonary functions which may lead to disastrous consequences.In the current case,after a chronic onset,the patient presented a large tumor within the anterior mediastinum,with chest tightness and dysphagia as the main clinical manifestations,and then massive pericardial effusion and occlusion of the right pulmonary artery developed in the supine position,with>50%of compressed airway and atelectasis.Then,reduction of preoperative volume,con⁃scious intubation and other methods were adopted to minimize cardiopulmonary pressure,which provided benefits for general anesthe⁃sia management during tumor resection.Also,reexpansion pulmonary edema was actively prevented after surgery.All the above proce⁃dures contributed to stable and safe perioperative management,where the patient was cured and discharged.This case can provide ref⁃erence for perioperative management of mediastinal tumors.