文档介绍：合并肢端肥大症的垂体腺瘤患者麻醉管理及并发症
作者:计根林施宇翔黄怡熊利泽谢莉顾建文张英民董辉
【关键词】麻醉
关键词: 麻醉;垂体腺瘤;肢端肥大症
摘要: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120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(SpO2 )≤90%发生率,困难插管评分(IDS)均明显高于对照组(P<),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<),血糖明显升高,、异丙酚、尼卡地平、艾司洛尔的用量亦明显大于对照组(P<),心率(HR)改变,万可松用量,术中液体入量,FiO2 ,PaO2 以及PaCO2 (P<). 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、血压明显升高以及水钠潴留可导致麻醉并发症及危险性增加.
Keywords:anesthesia;pituitary tumour;acromegaly
Abstract:AIM To investigate the changes in the clinical features of anesthetic management,safety and the incidence of plications in acromegaly 120patients of pituitary tumour with acromegaly,and anoth-er36non-acromegalic patient undergoing transsphenoidal or craniotomy pituitectomy were difficulties of mask ventilation,intubation difficulties and risks,the changes in hemodymamics and other plications were Difficulty airway,important gas flow leak from the face mask,tongue enlargement and blood oxyen saturation(SpO2 )≤90%were encountered more often and the intubation difficulty scale(IDS)was higher in the acromegalic patients than in the non-acromegalic patients needed significantly more fentenyl,propofol,nicardipine and esmolol than the control patients(all P<).The values of baseline mimimum and maxi-mam were higher in the acromegalic patients than those in the was no difference between the two groups in the use of vasoactive ,PaO2 ,PaCO2 ,SpO2 Et-CO2 and dose of vencronium were similar in both -terial pH was significantly lower(P<),blood glucose was higher(P<)and urinary output was lower(P<)in the acromegalic patients than in the control haemodynamic instabil
ity did not occur during surgery for the