喉癌手术的麻醉处理

目的：讨论喉癌手术患者的特殊性和麻醉中应该注意的问题。方法：回顾分析2006年2月至2007年2月我院行单纯喉切除术病人病案资料。结果：2006年2月至2007年2月我院共行单纯喉切除麻醉138例。138例病例中有84例为直接气管切开后插入气管内导管，其余54便为静脉快速导后插管术中气切换管。依据麻醉顺序将84例先行气切的病例分为A、B两组，A组为在气切前给予麻醉药物，B组为气切插管后马上给予麻醉药物。麻醉前两组间情况无显著差异。静脉麻醉诱导后气切插管前收缩压（SBP），舒张压（DBP），心率（HR）较麻醉前明显降低（P〈0.05），气切插管后，喉癌切除时、手术结束时各参数有些变化，但其波动大小基本上在正常范围之内。两组患者不同顺序麻醉气切，B组血液动力学参数变化较A组大，但两组患者术中、术毕各参数基本平稳正常，组间比较（P〉0.05），无明显差异。结论：讨论了些类患者的特殊性和麻醉中应该注意的问题，包括麻醉前评估喉癌患者的病变范围和是否存在气道阻塞及其程度，老年男性患者术前，术中呼吸循环系统并发症的处理，不同分型的肿瘤插管方式的选择，术中术后呼吸道管理的特殊性，术后拔管应该注意的问题。

Anesthetic Management of Operation for Throat Tumor

Objective：To evaluate some issues of clinical anesthesia during larynx carcinoma radical operation. Methods： A retrospective review of all patients presenting to larynx carcinoma radical operation under general anesthesia between February 1, 2006 and February 1, 2007. Results： 138 cases undergoing simple laryngectomy were included. 84 patients in group A were tracheostomied and infused appropriate doses intravenous anesthetics to achieve complete anesthesia induction, thereafter tracheal intubation were made. The other patients were induced after tracheal intubation in group B. The demographic datas were no different between two groups. The hemodynamic parameters （blood pressure and heart rate） declined significantly after intravenous anesthesia induction （P〈0.05）, but they were stable during radical operations. The blood pressure and heart rate increased obviously in group B during tracheostomy and tracheal intubation, but no differences were found between two groups. Conclusion ： It is important to evaluate patients suffered from larynx carcinoma conditions preoperatively. Choose effective methods to control patients＇ airway according to tumor staging, airway obstruction and cardiovascular and respiratory complications.