垂体瘤与非垂体瘤脑占位手术的麻醉管理体会

Anesthesia Management of Pituitary Tumor and Non-Pituitary Tumor Surgery

摘要: 目的：观察垂体瘤患者与非垂体瘤脑占位患者围术期的麻醉特点。方法：选择本院神经外科拟在全身麻醉下行脑占位切除术患者320例。其中，垂体瘤患者156例，非垂体瘤患者164例，作为观察组和对照组。两组患者依次静脉注射米达唑仑0.4 mg，丙泊酚2 mg∙kg⁻¹、舒芬太尼0.3 ug∙kg⁻¹，苯磺顺式阿曲库铵20 mg，快速诱导麻醉，气管插管，机械通气。术中通过丙泊酚靶控浓度维持BIS在40~60之间，间断追加舒芬太尼和顺式阿曲库铵。分别于术前、术中、术后及拔管后采取足背动脉血行血气分析，测定动脉氧分压(PaO₂)及动脉二氧化碳分压(PaCO₂)，并记录患者自主呼吸恢复时间、患者拔管时间，记录患者血压、心率以及术后并发症的发生情况。结果：垂体瘤患者组术前、术中、术后及拔管后动脉血氧分压均低于对照组(P < 0.05)，自主呼吸恢复时间和拔管时间大于对照组(P < 0.05)，而患者动脉二氧化碳分压两组无明显差异(P > 0.05)；D组高血压的发生率27.3%明显高于C组；与C组相比较，D组中有28例患者发生心率异常，差别有统计学意义；D组呼吸道梗阻的发生率明显高于C组(P < 0.05)，结论：垂体瘤影响患者呼吸、循环功能，使自主呼吸恢复时间延长，气管拔管时间延长，且垂体瘤患者术中血压、心率波动剧烈，围手术期应做好垂体瘤患者的呼吸及循环功能的麻醉管理。

Abstract: Objective: To observe the characteristics of perioperative anesthesia between patients with pituitary tumor and non-pituitary brain occupation. Methods: A total of 320 cases of patients in the neurosurgery department of our hospital with brain occupation who were intending to have surgery under general anesthesia were selected. Among them, 156 patients with pituitary tumor and 164 patients with non-pituitary tumor were served as the observation group and the control group. Patients in the two group were injected with midazolam 0.4 mg, propofol 2 mg∙kg⁻¹, sufentanil 0.3 ug∙kg⁻¹, and atracurium 20 mg, which were for rapid induction of anesthesia, endotracheal intubation, and mechanical. BIS was maintained at 40~60 through target controlled concentration of propofol during the operation; sufentanil and atracurium were added discontinuously. Preoperative, intraoperative, postoperative and post-extubation dorsal artery blood samples were taken for blood gas analysis. Blood gas analysis of dorsolateral foot arteries was performed before, during, after and after extubation, respectively. Partial arterial oxygen pressure (PaO₂) and partial arterial carbon dioxide pressure (PaCO₂) were measured, and the recovery time of spontaneous breathing, extubation time, blood pressure, heart rate and postoperative complications of the patients were recorded. Results: Preoperative, intraoperative, postoperative and post-extubation arterial oxygen partial pressure in the pituitary tumor group was lower than that in the control group (P < 0.05), the recovery time of spontaneous and extubation time was longer than that in the control group (P < 0.05), and there was no significant difference in arterial carbon dioxide partial pressure between the two groups (P > 0.05). The incidence of hypertension in group D was significantly higher than that in group C (27.3%); compared with group C, 28 patients in group D had abnormal heart rate, and the difference was statistically significant. The incidence of respiratory obstruction in group D was significantly higher than that in group C (P < 0.05). Conclusion: Pituitary tumor can affect the respiratory function and circular function of patients and prolong the postoperative recovery time of spontaneous and extubation time; besides, the blood pressure and heart rate of patients fluctuate violently during operation, so the perioperative anesthesia management of respiratory and circulatory functions of pituitary tumor patients should be done well.