骶骨肿瘤切除重建手术麻醉中的相关问题探讨(附158例报道)

目的对骶骨肿瘤切除重建手术麻醉中出现的各种相关问题进行探讨,以总结临床经验。方法对158例次骶骨肿瘤切除重建手术麻醉中出现的相关情况进行回顾性分析,以此总结手术麻醉中应当注意的问题。结果158例次患者术中出血量1 500~6 500 ml,平均3 500 ml;输血量1 000~6 000 ml,平均3 300 ml;术中行肿瘤切除时出现平均动脉压(MAP)下降至60 mmHg(1 mmHg=0.133 kPa)以下66例,发生率为41.77%(66/158),术中发生严重过敏反应8例,均得到及时有效处理。术中采用高容性血液稀释和控制性降压方法与单纯使用控制性降压比较,术中行肿瘤切除前者(血液稀释组)的血红蛋白与血球压积均较后者(对照组)下降(P<0.05),术后1 h行血液稀释组的两项指标与对照组无明显差异。两组在手术方式及术中出血量和输液量均无明显差异(P>0.05)。而术中输血量对照组较血液稀释组明显增加(P<0.05)。结论骶骨肿瘤手术出血量大,术中情况复杂,采用高容性血液稀释法及合理地控制性减压可以减少术中出血及输血量,围术期可能出现如过敏反应,交感反射,以及术中知晓、术后躁动等特殊情况,及时有效地处理是关键。

Problems Related to Anesthesia for Resection of Sacral Tumor:158 Cases Appended

Objective To discuss the problems related to anesthesia for resection of sacral tumor so as to provide appropriate experience in treatment.Methods A total of 158 cases of resection of sacral tumor were retrospectively analyzed and the problems related to anesthesia were summarized.Methods Blood loss,blood transfusion and blood pressure(BP) decline were recorded.Results Compared with control group,there were significant differences in hemoglobin(Hb) and hematocrit(Hct) in the trial group with hemodilution an...