放射性粒子植入治疗颌面部恶性肿瘤的麻醉处理

doi:10.3969/j.issn.1673-5749.2009.03.001

摘要/Abstract

摘要： 目的探讨放射性粒子植入治疗颌面部恶性肿瘤手术麻醉处理的特点。方法根据不同的适应证，将放射性粒子植入治疗颌面部恶性肿瘤的患者76 例分为局麻强化麻醉（LA组）、气管插管全身麻醉（TT组）和喉罩通气下的全身麻醉（LMA组），观察患者术中血压、心率和脉搏氧饱和度（SpO2）的变化以及麻醉诱导和维持的特点及并发症情况。结果 LA 组患者较TT 组和LMA 组患者术中心血管反应剧烈，术中最低SpO2 低于术前且低于TT 组和LMA组（P<0.05）；术中体动和疼痛程度高于TT 组和LMA组（P<0.05），1 例发生低氧血症。TT 组9 例发生气管插管困难，气管插管一次成功率62.5%，1 例术后因气道梗阻行紧急气管切开。LMA 组一次置入成功率90%，与TT 组术中的血流动力学和血氧比较差异无统计学意义（P>0.05），其中9 例术中出现漏气音，但无低氧发生。结论在颌面部粒子植入手术中，不同的麻醉方法适用于不同的适应证且各有特点。其中，局麻强化可能镇痛不全，气管全身麻醉易出现插管困难，喉罩通气置入成功率高且应用安全有效。

关键词: 麻醉, 颌面部, 恶性肿瘤, 放射性粒子

Abstract: Objective To investigate characteristics of anesthesia management for radioactive seed implantation in treatment of oral and maxillofacial malignant tumor. Methods 76 patients with oral and maxillofacial malignant tumor receiving treatment of radioactive seed implantation were given three types of anesthesia according to indications: Local anesthesia plus intravenous sedation（group LA）, general anesthesia with endotracheal intubation（group TT） and general anesthesia with laryngeal mask airway（group LMA）. Changes of patients′ blood pressure（BP）, heart rate（HR） and saturation of pulse oxygen（SpO2） during operation were recorded. Characteristics of anesthesia
induction and maintenance and perioperative complications were observed. Results Among the 76 patients, 12 patients were enrolled into group LA, 24 patients were enrolled into group TT and 40 patients were enrolled into
group LMA. Perioperative cardiovascular response in group LA was more intense than that in group TT and group LMA（P<0.05）. The lowest SpO2 during operation of group LA was lower than preoperative value and than that of group TT and group LMA（P<0.05）. Patients in group LA had more body movements and more pain than that in group TT and group LMA（P<0.05）. One patient of group LA had hypoxemia during operation. In group TT, 9
patients had difficult intubation and the successful rate of first insertion was 62.5%. One patient of group TT received emergency tracheotomy because of postoperative airway obstruction. The successful rate of first insertion in
group LMA was 90%. There was no difference between group TT and group LMA with respect to cardiovascular change and lowest SpO2. 9 patients of group LMA showed leakage during operation but no hypoxemia occurred.
Conclusion In maxillofacial radioactive seed implantation surgery, different anesthesia methods should be chosen according to indications. Local anesthesia plus intravenous sedation is not likely to produce perfect analgesia, while general anesthesia with endotracheal intubation may
have difficult intubation. Laryngeal airway mask is easy to insert and can be used under safety and feasibility in such operations.

Key words: anesthesia, maxillofacial, malignant tumor, radioactive seed

杨旭东, 董稳, 张建国. 放射性粒子植入治疗颌面部恶性肿瘤的麻醉处理[J]. 国际口腔医学杂志, 2009, 36(3): 253-255，259.

YANG Xu-dong, DONG Wen, ZHANG Jian-guo. Anesthesia management for radioactive seed implantation in treatment of oral and [J]. Inter J Stomatol, 2009, 36(3): 253-255，259.

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