局部进展期肿瘤患者手术联合术中放疗的麻醉管理  

Anesthetic management of locally advanced cancer patients treated with surgery and intraoperative radiation therapy

作　　者：黄志华[1] 罗艳[1] 于布为[1] 李一亮[1] HUANG Zhihua;LUO Yan;YU Buwei;LI Yiliang(Department of Anesthesiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medcine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,上海200025

出　　处：《上海医学》2020年第1期24-28,共5页Shanghai Medical Journal

摘　　要：目的回顾性分析使用可移动式术中放疗加速器(Mobetron)进行手术联合术中放疗(IORT)患者麻醉管理的结果。方法将160例局部进展期肿瘤患者随机分为手术联合IORT组(IORT组)和单纯手术组(对照组),每组80例。比较两组患者的麻醉管理相关参数和瘤床周围光子泄漏情况。结果两组间患者麻醉深度、复苏时间、术中失血量、输血量、尿量、晶体胶体输入量、最低体温、脉搏血氧饱和度、呼气末二氧化碳分压的差异均无统计学意义(P值均>0.05)。手术联合IORT组的手术时间和麻醉时间均显著长于单纯手术组(P值均<0.05)。手术联合IORT组无麻醉相关严重并发症发生。靶区周围正常组织吸收的剂量[0.20(0.02,0.30)Gy]显著低于靶区组织[12(10,20)Gy,P<0.01]。结论全身麻醉状态下患者完全可以耐受IORT,同时保持血流动力学和心肺功能稳定而无其他相关并发症发生。IORT可在手术室中实施,无需过度放射防护。Objective To analyze the anesthetic management of patients receiving a combination of surgery and intraoperative radiation therapy(IORT)using the Mobetron,a mobile electron accelerator.Methods A total of 160 patients with locally advanced primary or recurrent cancer were recruited in this study and were randomly assigned to IORT group(n=80)and control group(n=80).Parameters related to anesthetic management and exposure dose around the target tumor bed were compared between two groups.Results There were no significant differences in terms of the depth of anesthesia,recovery time,intraoperative bleeding volume,blood transfusion,urinary output,crystalloid and colloid infusion,lowest temperature,pulse oxygen saturation,or end-tidal CO2 partiol pressure between two groups(all P>0.05).IORT prolonged the total anesthesia and operation time(both P>0.05).No severe complications related to anesthesia occurred.The exposure dose around the target region was much lower than that in the target itself[0.20(0.02,0.30)Gy vs.12(10,20)Gy,P<0.01].Conclusion IORT is well tolerated during general anesthesia by patients with stable hemodynamic and cardiopulmonary function but without additional complications.Photon radiation from the Mobetron is so low that no additional shielding in the operating theatre is required.

关 键 词：麻醉 全身 术中放疗 局部进展期肿瘤 可移动式术中放疗加速器 

分 类 号：R614[医药卫生—麻醉学] R730.56[医药卫生—外科学]