异位ACTH肿瘤围术期麻醉管理  

Perioperative anesthetic management of ectopic ACTH syndrome

作　　者：毕素萍[1] 张宏[1] 陈知进[1] 

机构地区：[1]解放军总医院麻醉科,北京100853

出　　处：《军医进修学院学报》2005年第4期244-246,共3页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的:探讨异位促肾上腺皮质激素(ACTH)综合征安全可行麻醉方案。方法:5例患者经过术前补钾、降糖、降压准备,择期在全麻气管插管下行原位肿瘤切除术。麻药按正常剂量的1/2进行诱导,全组诱导后地塞米松10mg静注,2例切瘤后分别氢化考的松100mg静滴。间断测血气,于术日晨、术中分离瘤体、切瘤后0h、1h、5h抽静脉血测ACTH和皮质醇浓度。术后继续补钾、预防用氢化考的松。结果:2例术中血钾<2.5mmol/L,给予静脉补钾。剥离肿瘤时,ACTH较术前升高(P<0.01),切瘤后ACTH骤然降低,甚至低于正常(P<0.01)。1例术后8h发生肾上腺皮质危象,测血ACTH<2.2pmol/L,氢化考的松400mg静滴后血压、心率回升。术后24h内血钾、ACTH、皮质醇恢复正常。结论:术前补钾、降糖,改善全身状况,麻醉用药减半,术中、术后监测血钾、血糖、ACTH和皮质醇,切瘤后应用氢化考的松预防皮质醇危象,是协助患者安全度过手术的关键。Objective：To explore the best perioperative anesthetic management of ectopic ACTH syndrome, Methods：5 patients with ectopic ACTH syndrome underwent operations of resecting primary tumor during general anaesthesia after preoperative preparation of supplementing potassium and decreasing plasma glucose levels and reducing blood pressure. Anaesthetic dose was half of the normal usage. All patients were injected Dexamethasone 10mg after tracheal intubation. Two cases were intravenously infused hydrocortisone 100mg after cutting out neoplasms. Blood gas was periodly measured. Plasma ACTH and cortisol levels were also measured at the time of before operations, exposing tumors, after removing tumors Oh, lh and 5h, Potassium and hydrocortisone i. v, infusion were continued after operations. Results ：Two cases had severe hypokalemia and potassium was supplemented during operations. ACTH significantly increased when exposing tumors （P 〈 0.01 ） and markedly decreased when tumors were cut away（ P〈0.01 ）, Adrenocortical crisis occurred in one patient after 8h of postoperation. BP and HR gradually returned to normal range after using hydrocortisone. Plasma potassium and ACTH and cortisol went back to normal scope within 24h.Conclusion：It＇s important of perioperative supplementing potassium, diminishing plasma glucose, and preclusive using of hydrocortisone to help patients go through operations safely.

关 键 词：ACTH综合征 异位性 肿瘤 围手术期间 麻醉 

分 类 号：R614.2[医药卫生—麻醉学]