胰腺癌纳米刀消融术的麻醉管理:一项回顾性病例系列研究  

Anesthetic management of patients with pancreatic cancer undergoing nanoknife ablation:a retrospective case series study

作　　者：王永徽 路志红 刘正才 范倩倩 Wang Yonghui;Lu Zhihong;Liu Zhengcai;Fan Qianqian(Department of Anesthesiology and Perioperative Medicine,Xijing Hospital,Air Force Medical University,Xi'an 710032,China;Depart-ment of Hepatobiliary Surgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院麻醉与围术期医学科,西安710032 [2]空军军医大学西京医院肝胆外科,西安710032

出　　处：《国际麻醉学与复苏杂志》2023年第5期484-488,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的总结胰腺癌患者行开腹纳米刀消融术的围手术期并发症和麻醉管理经验。方法采用描述性病例系列研究方法,回顾性分析31例行开腹纳米刀消融术的胰腺癌患者的临床资料,包括患者基本情况、麻醉管理策略。主要指标包括消融期高血压、低血压、心动过速和心律失常的发生率。次要指标包括消融期SBP、DBP最大升高和降低百分比,心率最大增快和减慢百分比,术中血管活性药物使用率,术后24 h静息和活动VAS疼痛评分,术后住院时间及总住院时间。结果31例患者年龄(59±10)岁,ASA分级Ⅱ级24例、Ⅲ级7例,最常见的术前合并症是高血压(38.7%),常出现的症状是腹痛(64.5%)和腹胀(35.5%),肿瘤多位于胰腺头颈部(80.4%)。所有患者均在全麻下完成手术并在术中进行了腹腔神经丛阻滞,其中3例患者辅助使用了胸椎旁神经阻滞,2例患者辅助使用了硬膜外麻醉。消融期77.4%的患者出现高血压,80.6%的患者出现低血压,58.1%的患者既出现了高血压也出现了低血压,51.6%的患者需要使用升压药,67.7%的患者需要使用降压药;35.5%的患者出现了一过性心动过速;9.7%的患者出现了一过性心律失常。与麻醉前比较,消融期SBP最大升高百分比为10.1%(95%CI 2.4%~17.9%),DBP最大升高百分比为12.9%(95%CI 4.5%~21.4%),心率最大增快百分比为19.2%(95%CI 11.5%~27.0%);SBP最大降低百分比为−36.0%(95%CI−40.9%~−31.0%),DBP最大降低百分比为−32.1%(95%CI−37.1%~−27.1%),心率最大减慢百分比为−28.7%(95%CI−32.6%~−24.7%);患者麻醉时间为(305±69)min,手术时间为(266±69)min。患者术后均在手术室拔除气管导管,安全返回病房。术后24 h静息VAS疼痛评分为(2.5±1.1)分,活动VAS疼痛评分为(4.2±1.8)分。术后住院时间(11±5)d,总住院时间(16±6)d。结论胰腺癌纳米刀消融术患者围手术期高血压和低血压发生率高,可发生一过性心律失常。消融期深肌松、心电�Objective To summarize the perioperative complications and anesthesia management experience of patients with pancreatic cancer who underwent nanoknife ablation.Methods A descriptive case series study was conducted to retrospectively analyze the clinical data of 31 pancreatic cancer patients who underwent nanoknife ablation.Their basic information and anesthetic management strategies were collected.The primary outcomes were the incidences of hypertension,hypotension,tachycardia and arrhythmia.The secondary outcomes included the percentages of maximum increases and decreases in systolic blood pressure(SBP)and diastolic blood pressure(DBP),the percentages of maximum increases and decreases in heart rate,the use of vascular active agents during surgery,the Visual Analogue Scale(VAS)scores at rest and during movement at postoperative 24 h,and the length of postoperative and total hospitalization stay.Results These patients had a mean age of(59±10)years old,where 24 patients were American Society of Anesthesiologists(ASA)Ⅱgrade and 7 patients were ASAⅢ.The most common preoperative comorbidity was hypertension(38.7%).The common symptoms included abdominal pain(64.5%)and abdominal distension(35.5%),and 80.4%of tumors were located at the head and neck of the pancreas.All the patients underwent surgery under general anesthesia and celiac plexus block was conducted during surgery,where thoracic paravertebral block was additionally applied in 3 patients and epidural anesthesia was also applied in 2 patients.During the ablation period,77.4%of patients presented hypertension,80.6%had hypotension,58.1%had both hypertension and hypotension,51.6%required vasopressors,67.7%required antihypertensive drugs,35.5%showed transient tachycardia,and 9.7%had transient arrhythmia.Compared with those before anesthesia,the percentage of maximum increases in SBP,DBP and heart rate during ablation was 10.1%[95%confidence interval(CI)2.4%,17.9%],12.9%(95%CI 4.5%,21.4%),and 19.2%(95%CI 11.5%,27.0%),respectively;and the percentage of maximum

关 键 词：胰腺癌 不可逆电穿孔 麻醉管理 回顾性 消融术 

分 类 号：R735.9[医药卫生—肿瘤] R614[医药卫生—临床医学]