颅底外科手术麻醉及围术期处理86例

Anesthesia and perioperative management for skull base surgery

目的 :总结 86例颅底手术患者的麻醉及围术期处理的特殊性 .方法 :依术前病情 ,予胃管鼻饲、静脉内高营养(2 1例 )、行气管切开术 (13例 )和心血管系统药物治疗 (46例 ) ,根据有无颅内压增高和大出血倾向等临床表现 ,将患者分为四类 ,针对各类患者病情特点 ,采取静吸复合全身麻醉 ,控制性降压 ,适度过度通气 ,自身血液稀释以及浅低温等 .结果 :手术时间平均 2 19(12 5～ 810 )min ,术中出现低血压 11例 ,心律不齐 3 8例 ,71例术毕 10min内苏醒 ,10例术后继续机械呼吸支持 ,3例留置气管导管 12h以上 ,71例愈后良好 ,5例死亡 ,无麻醉并发症 .结论 :此类患者手术麻醉应重视术前准备 ,实施计划麻醉 。

AIM: The characteristics of perioperative treatment and anesthesia for skull base surgery in 86 patients were summarized. METHODS: According to preoperative general conditions of patients, nasogastric tube feed and intravenous hyperalimentation ( n =21), tracheotomy ( n =13) or cardiovascular drugs therapy ( n =46) were implemented. Patients were divided into 4 categories by clinical manifestations such as with or without intracranial pressure elevation and tendency to mass bleeding and anesthesia of combined intravenous and inspired anesthesia, controlled hypotension, moderate hyperventilation, autogenous hemodilution or mild hypothermia were carried out accordingly. RESULTS: The average time of operation was 219 min (125～810 min ). Hypotension ( n =11) and arrhythmia ( n =38) occurred during operation. Seventy one patients were well conscious within 10 min after operation. Tracheal intubation remained more than 12 h in three patients and respiration was supported by mechanical ventilation in ten patients after operation. Seventy one cases had good recovery without anesthetic complications and five cases died. CONCLUSION: Great attention should be paid to the preoperative preparation, individual oriented administration of anesthesia, integrated management during the operation and prevention of postoperative complications in skull base surgery.