巨大纵隔肿瘤切除术患者围术期麻醉管理与ERAS建议流程  

Perioperative anesthetic management of patients undergoing resection of huge mediastinai mass andrecommendations tor enhanced recovery atter surgery protocol pathway

作　　者：张明珠[1,2] 娄志超 申乐 李虹[1] 张秀华[1] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,100730 [2]中国医学科学院肿瘤医院麻醉科 [3]北京航天中心医院麻醉科

出　　处：《中华麻醉学杂志》2017年第9期1037-1042,共6页Chinese Journal of Anesthesiology

摘　　要：目的纵隔肿物常由于其特殊的解剖位置造成麻醉及手术风险极大，本文旨在对3例巨大纵隔肿瘤切除术的围术期麻醉管理进行分析，明确此类手术潜在的风险，总结相应的围术期管理流程。 方法对本院近期收治的3例巨大纵隔肿瘤患者进行回顾性分析，从术前评估与准备、术中麻醉管理、术后镇痛治疗及围术期特殊情况的处理等方面进行汇总分析，在此基础上结合国内外文献报道，并基于现有加速术后康复（ERAS）流程提出此类手术的ERAS建议流程。 结果3例巨大纵隔肿瘤分别为胸膜恶性孤立性纤维性肿瘤、胸腺鳞癌和混合型生殖细胞肿瘤。术前评估重点为肿瘤对纵隔内其他重要器官的影响；围术期需要关注大出血、心功能不全、呼吸功能不全等严重并发症；患者术后均返回ICU进一步治疗，并顺利康复出院；完善术后镇痛有助于巨大纵隔肿瘤切除术患者的术后康复。 结论巨大纵隔肿瘤切除术围术期麻醉管理风险高，根据现有文献证据结合此类手术特点，提出ERAS建议流程，有助于减少并发症，促进患者术后康复。Objective The mediastinal mass usually posed higher risk of anesthesia and surgery due to its especial anatomical position, and this study aimed to analyze the perioperative anesthetic manage- ment of 3 patients undergoing resection of huge mediastinal mass, to identify the potential risks for this type of surgery and to summarize the corresponding perioperative anesthetic management protocol. Methods Three cases recently underwent resection of huge mediastinal mass in our hospital were reviewed. Their pre- operative assessment and preparation, intraoperative anesthetic management, postoperative pain manage- ment and special interventions needed in the perioperative period were summarized and analyzed retrospec- tively. The enhanced recovery after surgery （ERAS） protocol was established for this type of surgery based on the analysis mentioned above, evidence reported at home and abroad and currently available ERAS pro- tocols for other surgeries. Results Pleural malignant solitary fibrous tumor, thymus squamous cell carcino- ma and malignant mixed germ cell tumor were the three mediastinal masses. The preoperative assessment fo- cused on the impact of tumor on other vital organs within the mediastinum ; anesthesiologists focused on mas- sive hemorrhage and severe complications such as cardiac insufficiency and respiratory insufficiency; all the three patients were sent to the intensive care unit after surgery for further treatment, successfully recovered and were discharged ; improving postoperative analgesia was helpful for recovery after resection of huge medi-astinal mass. Conclusion Perioperative anesthetic management of＂ patients undergoing resection of huge mediastinal mass is related to high risk, and establishing specific ERAS protocol is helpful in reducing com- plications and in promoting recovery after surgery based on the currently available evidence and characteris- tics of this type of surgery.

关 键 词：纵隔肿物 围术期管理 加速术后恢复 

分 类 号：R614[医药卫生—麻醉学] R734.5[医药卫生—外科学]