摘要
[目的]探讨全身高温疗法(wholebodyhyperthermia,WBH)的麻醉管理特点,提高WBH疗法的麻醉管理水平。[方法]25例晚期癌症患者,采用ET鄄SPACETM鄄I红外线全身热疗系统加温,静吸复合全麻,监测心率(HR)、脉搏血氧饱和度(SPO2)、心电图(EKG)、呼气末二氧化碳分压值(PetCO2)、平均肺动脉压(PAP)、中心静脉压(CVP)、平均动脉压(MABP)、肺毛细血管嵌压(PCWP)、心排血量(CO)、心脏指数(CI)、外周血管阻力(SVR)、肺动脉血管阻力(PVR)、动脉氧饱和度(SaO2)、血糖和肾功能。[结果]随着体温的升高,血流动力学和氧代谢参数出现明显的变化。HR、CO、CI、CVP、MPAP、PCWP均升高,恒温期间最明显,而此期MABP、PVRI、SVRI反而下降(P<0.01);在高温状态下,心脏功能受抑制,肺水严重增多,氧耗与氧供均升高。与一般全麻比较,药物分解代谢增快,所需麻药量增多。[结论]充分的麻醉前准备,合理的麻醉用药,完善的监控手段,适当的血管活性药物的应用,充分的氧供,酸碱平衡,血气电解质稳定,高血糖以及各器官功能的维护和合理补液,均有助于提高WBH麻醉的安全性。
To observe the variation and improve the level of anaesthesia management during whole body hyperthermia.Twenty-five patients with advanced cancer were treated with whole body hyperthermia by ET-SPACETM-I infared radiation,A series monitoring were carried out.Parameters including heart rate(HR),SPO2,electrocardiogram(EKG),PetCO2,pulmonary artery resistance(PAP),central venous pressure(CVP),mean pulmonary artery pressure(MABP),pulmonary capillary wedge pressure(PCWP), cardial output(CO), cardial index (CI), systemic vardiac resistance (SVR), pulmonary vascular resistance(PVR),mixed venous O2 sartarations (Sa-vO2), urine volume,blood sugar and renal function.The hemodynamics and parameters of oxygen metabolism changed with temperature rise.While HR,CO,CI,CVP,MPAP and PCWP increased,MABP?PVRI?SVRI decreased in evidence in homeothermia stage.Cardiac function was restrained with severe pulmonary edema,both oxygen consumption (VO2) and oxygen delivery(DO2)increased during hyperthermia.Drug catabolism acceleration and comsumption increased with hyperthermia than those without hyperthermia.[Conclusion]Sufficiently preanesthetic preparation,reasonably medication,consummately monitoring methods,properly application of blood vessel drugs,well controlled fluid infusion,sufficiently oxygen-supply,keeping acid-base balance,electrolure stabilizing and hyperglycemia, maintain function of organs would be of benefit to WBH and improve safety.
出处
《中国肿瘤》
CAS
2004年第8期530-533,共4页
China Cancer
基金
广州市科技攻关基金课题(2002Z3-E0013)
关键词
高温疗法
肿瘤
治疗
麻醉
hyperthermia
neoplasms
treatment
anaesthesia
