术中腹腔内持续热灌注化疗术对腹腔假黏液瘤患者围术期呼吸力学、血流动力学及生化代谢的影响  

The effect of continuous hyperthermic peritoneal perfusion in patients with pseudomyxoma peritoneal on respiratory function, hemodynamics and metabolism parameters

作　　者：杨占民[1] 郑翔丽[1] 梁汉生[1] 陶德强[1] 付强[1] 张古月[1] 

机构地区：[1]航天中心医院麻醉科,北京100049

出　　处：《北京医学》2014年第8期639-642,共4页Beijing Medical Journal

摘　　要：目的 观察腹腔内持续热灌注（continuous hyperthermic peritoneal perfusion,CHPP）对腹腔假黏液瘤手术患者呼吸力学、血流动力学及生化指标的影响。方法 ASAⅠ-Ⅲ级择期腹腔假黏液瘤手术患者20例,吻合口缝合完毕后进行CHPP。手术和热化疗过程中进行呼吸力学、血流动力学及生化代谢监测。结果 CHPP过程中颅脑温（鼻咽温）增高明显（P〈0.05）,CHPP后30 min颅脑温依然显著增高,气道峰压（Ppeak）增高,顺应性（Compl）降低（P〈0.05）,CHPP结束后恢复正常;PCO2在CHPP 15 min后开始显著增加;心率（HR）显著增快;平均动脉压（MAP）显著下降,CHPP结束后30 min恢复到热灌注前水平;血糖快速升高,CHPP开始前即需要应用胰岛素控制血糖,随CHPP时间的延长,胰岛素的用量增加,CHPP结束后血糖水平开始下降（P〈0.05）;CHPP期间血浆钾、钠离子浓度下降（P〈0.05）;pH、BE、HCO3-显著下降（P〈0.01）。CHPP过程中HR加快与体温上升有良好的相关性（r=0.976,P〈0.05）。结论 CHPP主要引起体温上升、血糖升高及继发的一系列血流动力学与生化变化,对机体内稳态产生较大的影响。术中需有较好的监测,及时预防与处理,麻醉管理还是安全可控的。Objective To evaluate the effects of continuous hyperthermic peritoneal perfusion （CHPP） on respirato-ry, cardiovascular system and biochemical parameters. Methods Twenty ASAⅠ-Ⅲ patients underwent cytoreductive surgery followed by CHPP were involved. The respiratory function, hemodynamics and biochemical parameters were recorded during the whole procedure. Results The nose temperature （T） increased significantly during CHPP. Respiratory function changed markedly, and PCO2 raise significantly 15 min after CHPP. Heart rate increased during CHPP and re-turned to （92.8 ±12.6） bpm （P〈 0.05） after CHPP. During CHPP, the mean artery pressure decreased significantly （P〈0.05）, meanwhile, CVP also increased significantly, which returned to normal when CHPP was ended. For biochemi-cal metabolism, the blood glucose level changed significantly after CHPP, so it should be necessary to use insulin to con-trol blood glucose level before CHPP. Along with the CHPP, the dosage of insulin increased. After CHPP, the levels of blood glucose began to fall, during CHPP, plasma potassium and sodium ion concentration decreased, pH, BE and HCO 3-also decreased significantly. During CHPP, the increase of HR had good relationship with the change of blood temperature （r=0.976, P〈0.05）. Conclusion During CHPP, the hemodynamic and biochemical parameters change significantly. It is necessary to monitor and manage during anesthesia to ensure the safety of patients.

关 键 词：血流动力学 呼吸力学 血气分析 腹腔内持续热灌注 腹腔假黏液瘤 

分 类 号：R735[医药卫生—肿瘤]