前纵隔肿瘤的围术期麻醉管理  

Perioperative anaesthetic management of anterior mediastinal mass

作　　者：郭剑[1] 金旭东[1] 陈祥明[1] Guo Jian Jin Xudong Chen Xiangming(Department of Anesthesiology, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Chin)

机构地区：[1]浙江大学医学院附属第四医院麻醉科,义乌322000

出　　处：《国际麻醉学与复苏杂志》2016年第1期54-57,61,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：背景 前纵隔肿瘤对循环、呼吸影响重大,给手术麻醉带来极大挑战. 目的 为前纵隔肿瘤手术麻醉方案的制定和后续研究提供参考. 内容 对近年前纵隔肿瘤手术麻醉相关的病例进行回顾分析. 趋向 全身麻醉风险分级为“不安全”的前纵隔肿瘤患者应尽量避免全身麻醉,无法避免者,应在充分评估及准备下实施,术前在局部麻醉下行股动静脉穿刺,备体外循环是有必要的.全身麻醉诱导时,应在最适体位下缓慢进行,保持自主呼吸,只有当插管顺利且确保在气管内时,才可使用肌松剂.术中突发通气困难,在纤维支气管镜引导定位失败后,应紧急建立体外循环.术后拔除气管导管应在充分评估气道后实施.Background Anterior mediastinal mass makes great challenges to the anesthesiologist due to their significant impacts on the circulation and respiration.Objective To provide reference for making adequate perioperative anaesthetic management of anterior mediastinal mass and the subsequent research.Content This review restrospectively analyzes perioperative anaesthetic management of anterior mediastinal mass in relevant articles and case reports.Trend Patients,stratification of mediastinal mass regarding safety for general anesthesia is ＂unsafe＂,should avoid general anesthesia as far as possible.When general anesthesia can not be avoided,full evaluation and preparation should be taken,and having their femoral vessels cannulated in readiness for cardiopulmonary bypass is necessary.General anesthesia should be induced mildly in the proper position maintaining autonomous breathing.Muscle relaxants can be used until the patient is intubated smoothly and confirmed.If faced with sudden difficult ventilation or failed in bronchoscopy guided reintubation,emergent cardiopulmonary bypass should be eatablished.Fully assessment of the airway should be done before decannulation.

关 键 词：纵隔肿瘤 麻醉 体外循环 

分 类 号：R614[医药卫生—麻醉学] R734.5[医药卫生—外科学]