后腹腔镜下嗜铬细胞瘤切除术麻醉处理

Anesthesia for surgery on Pheochromocytomas with retroperitoneal Laparoscopy

关键词:  后腹腔镜  嗜铬细胞瘤  麻醉  血管活性药物

Key words:  retroperitoneal Laparoscopy  pheochromocytoma  anesthesia  active drugs of blood vessels

摘要:

［目的］ 总结8例后腹腔镜下肾上腺嗜铬细胞瘤切除术的麻醉及其管理经验。［方法］对8例后腹腔镜下肾上腺嗜铬细胞瘤切除术病人的麻醉资料进行分析。在充分术前准备的基础上，采用单纯全麻5例，全麻复合硬膜外麻醉3例。全麻诱导采用咪唑安定、芬太尼、异丙酚、罗库溴铵及气管内表麻，术中根据PETCO₂和PaCO₂调节呼吸参数，术中麻醉维持采用吸入异氟醚，微量泵泵入异丙酚和瑞芬太尼。全麻复合硬膜外麻醉者，给硬膜外试验剂量后全麻诱导，术中间断经硬膜外导管给予局麻药。肿瘤切除前，使用酚妥拉明降压，必要时加用硝普钠，肿瘤切除后，减浅麻醉，加快输液，使用多巴胺或复合去氧肾上腺素维持循环。［结果］在探察、分离肿瘤过程，血压均有升高，尤以单纯全麻更为明显。肿瘤切除后，均有不同程度的血压降低，给予多巴胺或复合去氧肾上腺素很快可以恢复血压在安全范围，8例术终均清醒拔管。［结论］完善的术前准备，血管活性药物的合理应用，恰当的麻醉选择和管理，严密的监测是可以保证后腹腔镜下肾上腺嗜铬细胞瘤切除术的顺利完成。

Abstract:

［Objective］To summarize the anesthesia experience for surgery on Pheochromocytomas with retroperitoneal Laparoscopy .［Methods］By analysing clinical anesthesia material of 8 patient undergoing surgery on Pheochromocytomas with retroperitoneal Laparoscopy. 5 patients were under general anesthesia and the other 3 patents were under general anesthesia combined with epudiral anesthesia respectively. After induced with midazolam、fentanyl、propofol and intubated with rocuronimu,Regulated tide volume according to the values of PETCO₂and PaCO₂. Maintained anesthesia with isoflurance inhalation and propofol、remifentanil infusion. Patients under general anesthesia combined with epudiral anesthesia, after inserted epidural catheter and injected test doses, underwent anesthesia induction and injected 1.5%lidocaine through the catheter if necessarily. Before Pheochromocytomas being removed, Regitine was used, and if necessarily, niprode was added. After Pheochromocytomas being removed, Some measures, including reducing anesthetic and acceleraing the infusion, were used. ［Results］Blood pressure of the patients rised during searching and detaching the Pheochromocytomas in general and those patients only under general anesthesia in particular.Immediately Pheochromocytomas being removed, all the patients showed hypotension to some degree. giving dopamine and Phenylephrine could help return the blood pressure to the range of security. All patients waked and were extubated in the end of the surgery.［Conclusions］satisfying preoperative preparations, adequate using the active drugs of blood vessels , reasonable management for anesthesia and closely mintoring are the key factors to succeddful surgery on Pheochromocytomas with retroperitoneal Laparoscopy.