合并冠状动脉三支病变老年患者行开胸左下肺巨大肿物切除术围手术期麻醉管理1例

Perioperative anesthesia management for elderly patients with three‑vessel coronary artery disease undergoing resection of a large mass in the left lower lung:A case report

肺癌是目前全球病死率最高的癌症之一。文中病例患者为左下肺非小细胞肺癌,癌组织范围大;合并冠状动脉三支病变,其中两支冠状动脉狭窄严重,回旋支近段狭窄约90%,右冠状动脉近段狭窄约80%;术前存在中度肺通气功能障碍及精神症状。该患者病情复杂,围手术期管理难度大,术前经过详细评估,术中采用预防心肌缺血、肺保护性通气策略、目标导向液体治疗等措施,最终较为顺利地完成了手术,患者平稳出院。总结该病例经验,以期为肺癌围手术期管理提供参考。

Lung cancer has the highest mortality among all cancers around the world.In this case,the patient has a large non‑small‑cell lung carcinoma of left lower lung.He also suffered from three‑vessel coronary artery lesions,two of which were severe coronary artery stenosis,with proximal stenosis in about 90%of the circumflex coronary and about 80%of the right coronary artery.He also manifested moderate pulmonary ventilation dysfunction and mental symptoms before surgery.The patient's condition was complicated,and the perioperative management was difficult.After detailed preoperative evaluation,measures such as prevention of myocardial ischemia,lung protective ventilation strategy and goal‑directed fluid therapy were adopted during the operation,and the operation was successfully completed,patient was discharged peacefully.The experience of this case was summarized,so as to provide reference for perioperative management of lung cancer.