腹腔镜嗜铬细胞瘤切除术的麻醉方法探讨.doc

腹腔镜嗜珞细胞瘤切除术的麻醉方法探讨 钟锦秀 广东省高州市人民医院麻醉科（525200） 【摘要】目的 探讨适合腹腔镜肾上腺嗜珞细胞瘤切除手术的麻醉方法。方法 24例腹腔镜嗜锯细胞瘤切除手术患者，随机分为两组：全麻组（A组）和全麻+ 硬膜外组（B组），每组12例。观察2组患者术屮血流动力学变化和并发症的发 牛率。结果 两组患者在肿瘤切除前后均出现明显的血流动力学变化，但B组 血压、心率波动明显小于A组（P0. 05）,麻醉清醒及拨管时间、并发症的发牛 率均明显少于A组（P0. 05） o结论 全麻+币更膜外阻滞应用于腹腔镜嗜辂细胞 瘤切除手术麻醉，术小血流动力学波动范围小，并发症少，是-?种较好的麻醉方 法。 【关键词】腹腔镜;嗜洛细胞瘤;麻醉;血流动力学 Investigate the anesthetic way of laparoscopic adrenalectomy for pheochromocytoma ZHONG Jin Xiu. Department of Anesthesiology, GAO-ZHOU PEOPLE Hospital . Guang-Dong 525200 CHINA 【Abstract 】 Objective To investigate the anesthetic way of laparoscopic adrenalectomy for pheochromocytom.Methods Twenty-four patients were divided randomly into two groups with 12 in each group.Group A underwent laparoscopic adrenalectomy for pheochromocytom under general anesthesia,while group B received the operation under general anesthesia combined with extradural anesthesia.Among all the patientsJiemodynamic changes and the complication rate were observedResults During the whole surgery,distintive hemodynamic changes were present in both groups,but the fluctuation of blood pressure and heart rate in group B were apparently lower than those in group A (PV0.05) ? Besides, compared with group A, not only din it take less time for the patients of group B to become comscious after anesthesia, but al so time of decamnidation was shorten, with lower complication rate.Conclusinon The application of general anesthesia combined with extradural anesthesia in laparoscopic adrenalectomy for pheochromocytom is a better choice with lower hemodynamic changes and complication rate . 【Key words ] Laparoscopic;Pheochromacytoma;Anesthesia;Hemodynamic changes 近年來随着微创外科的发展、腔镜技术不断进步，腹腔镜用于治疗肾上腺 嗜珞细胞瘤在临床上已逐渐成为主要的治疗手段之一巴但由于嗜钮细胞瘤可引 起体内大量儿茶酚胺的分泌，导致患者出现高血压、心律失常等一系列的病理牛 理变化，使病人的手术风险加大，同吋也增加了麻醉管理的难度。我院自2007 年3刀至2009年6刀在腹腔镜下行肾上腺嗜锯细胞瘤切除术24例，现将有关麻 醉方法的选择和处理经验总结如下： 1资料与方法 1?1 一般资料 肾上腺嗜鎔细胞瘤患者24例，男14例，女10例；年龄20?55 (36.2±8.1)岁,体重 45-76 (56.1 ±9.9) kg,病程 7 天?10 年,平均(28.4 ±3.2)刀。术前ASA分级为1?11级。术前经B超