合并肢端肥大症的垂体腺瘤患者麻醉管理及并发症论文.docVIP

　　合并肢端肥大症的垂体腺瘤患者麻醉管理及并发症论文 .freelour;acromegaly Abstract:AIM To investigate the changes in the clinical features of anesthetic management，safety and the incidence of major plications in acromegaly patients.METHODS 120patients of pituitary tumour egaly，and anoth-er36non-acromegalic patient undergoing transsphenoidal or craniotomy pituitectomy ask ventilation，intubation difficulties and risks，the changes in hemodymamics and other anesthetic plications portant gas flo the face mask，tongue enlargement and blood oxyen saturation（SpO2 ）≤90%ore often and the intubation difficulty scale（IDS）egalic patients than in the non-acromegalic patients.Acromegalic patients needed significantly more fentenyl，propofol，nicardipine and esmolol than the control patients（all P 0.05）.The values of baseline mimimum and maxi-mam egalic patients than those in the controls.There ilar in both groups.Ar-terial pH egalic patients than in the control patients.Severe haemodynamic instability did not occur during surgery for the acromegaly patients.CONCLUSION Airore freguently，and，IDS，glucose and blood pressure ore higher in the arromegalic patients than in the controls.Anesthetic plications occurred more often and introperaty morbidities e-galic patients than in the control patients. 0 引言 垂体腺瘤在临床上症状很多，既可表现为肢端肥大或巨人症及Cushing’s征，又可以其他形式表现.由于生长激素（groone，GH）持续分泌过多，致软骨组织和内脏过度生长，呈肢端肥大表现，特别是喉咽部解剖组织结构增生肥厚性的改变使麻醉诱导时呼吸道管理和气管插管极为困难.迄今，面罩通气、气管插管困难或失败仍为麻醉诱导插管所致重大并发症和死亡的主要因素［1］ .又因垂体腺瘤还可引起代谢紊乱，糖尿病［2，3］ ，心肌病变［4］ 和肺功能失调［5］ ，其围手术期病残率和病死率明显增加.为此，我们旨在评估肢端肥大症患者呼吸道管理的危险性以及麻醉并发症的发生情况. 1 对象和方法 1.1 对象 择期行经蝶窦或开颅垂体瘤摘除术患者120例，均合并肢端肥大症.同时，基于上述患者年龄、体质量以及性别另选非肢端肥大的同类患者36例为对照组（Tab1）.所有患者均经CT或MRI确诊.对所使用之药物过敏者以及术中大出血者不纳入本观察组内. 表1 患者一般情况和术中特征 略 1.2 方法 1.2.1 麻醉与监测 术前30min肌注哌替啶1mg kg-1 ，异丙嗪0.5mg kg-1 和东莨菪碱0.05mg kg-1 .入室后予以地塞米松0.2mg kg-1 和法莫替叮0.8mg kg-1 静注，麻醉诱导前完成插管后行桡动脉穿刺置管测压及右股静脉置管，建立输液通道.术中常规心电图（ECG，II），脉搏血氧饱和度（SpO2 ）以及收缩压（SBP）舒张压（DBP）及平均动脉压（MAP）监测，以咪唑安定0.03～0.05mg kg-1 ，芬太尼3～5μg kg-1 ，异丙酚1.0～1.5mg k