晚期恶性肿瘤患者全身热疗期的输液策略与肺水肿并发症  

Transfusion and pulmonary edema during whole body hyperthermia in advanced malignancy patients

作　　者：陶明哲[1] 李涵葳[1] 袁静[1] 赵雷[1] 任永功[1] 刘雅洁[1] 

机构地区：[1]暨南大学第二临床医学院深圳市人民医院麻醉科,518020

出　　处：《医师进修杂志（外科版）》2005年第12期9-11,14,共4页

基　　金：深圳市科技局立项资助项目(编号:JH20050507141145A)

摘　　要：目的探讨晚期恶性肿瘤患者全身热疗期的输液策略及肺水肿情况。方法选择ASAⅡ-Ⅲ级、心肺功能良好的晚期恶性肿瘤患者23例，用红外线辐射体表加热技术，在静脉全麻下实施全身热疗26人次。连续监测有创血流动力学、气道压、尿量，定期进行动脉、混合静脉血血气分析和血糖监测，并以此调节输液量和成分。记录热疗各时段输液和肺水肿情况。结果热疗期输液：升温早期为（23．6±3．2）ml/（kg·h），恒温期（19．1±2．9）ml/（kg·h），降温期（9．3±3．6）ml/（kg·h）；输液总量：晶体液（5168±578）ml，胶体液（1890±391）ml；热疗期体液呈正平衡约5000ml；热疗期肺水肿发生率为15．4％，热疗后24h内有53．8％的患者出现轻度肺水肿，热疗中发生肺水肿者，气道峰压持续升高（〉30cmH2O，1cmH2O=0．098kPa），肺氧合各指标明显下降，其输液速率和总量均高于无肺水肿者（P〈0．01）。结论热疗期应分时段输液管理，升温期较快、恒温期减慢、降温期控制输液；热疗期肺水肿发生率高，输液过快和过量可能会增加肺水肿的发生，热疗期呼吸力学和肺氧合等监测，对肺水肿的诊断和治疗有重要意义。Objective To study transfusion and puhnonary edema during whole body hyperthermia（WBH） in advanced malignancy patients. Method Twenty three patients （ ASA Ⅱ-Ⅲ,advanced malignancy ） accepted WBH amount to 26 times using general anesthesia. Continuous hemodynamics parameters, airway pressure （Peak）,urine volume,and periodical blood gas analysis of artery and mixed venous blood were measured. Transfusion was adjusted according to these measured parameters. In the mean time,the volume of infused fluid and pulmonary edema were recorded. Result The volume of transfusion in the heating phase, the plateau phase and the cooling phase was （23.6 ± 3.2） ml/（kg·h）, （19.1 ± 2.9） ml/（kg· h） ,and （9.3 ± 3.6） ml/（kg· h） respectively; The total volume of crystalhid solution and colloid solution was （5168 ± 578） ml, （1890 ± 391 ） ml respectively. The incidence of pulmonary edema in the plateau and cooling phase was 15.4%. 53.8% patients underwent gentle pulmonary edema in 24 hours after WBH. The patients who underwent pulmonary edema during WBH had continuously higher Peak （ 〉 30 cm H2O, 1 cm H2O = 0.098 kPa）, obviously worse oxygenation, and significantly higher volume of transfusion and colloid solution than the patients without pulmonary edema had （ P 〈 0. 01）. Conclusion Different transfusion should be executed during WBH as following, more and faster in heating phase,less in plateau phase,and limited in cooling phase. Rapid and over - dose of transfusion increased the risk of pulmonary edema. It is important to monitor breathing mechanics and oxygenation for diagnosis and treatment of pneumonedema.

关 键 词：全身热疗 输液 肺水肿 肿瘤 

分 类 号：R730.5[医药卫生—肿瘤]