延髓肿瘤开颅手术患者围手术期呼吸功能的管理分析

Analysis of management of respiratory function in patients with medulla oblongata tumor treated by craniotomy in perioperative period

摘要:

目的 延髓肿瘤围手术期呼吸功能的麻醉管理。方法 回顾性分析北京天坛医院神经外科延髓肿瘤手术患者的病例资料,重点分析此类患者的麻醉期间和围手术期呼吸功能管理。结果 2014年1月至10月有28例延髓肿瘤患者入组,病理性质以胶质瘤为主;术前吞咽功能障碍及呼吸功能异常比率分别为46.4%(13/28) 和3.6%(1/28),术中经鼻插管比率为42.8%(12/28);有75%(21/28)患者采取术后保留气管导管观察,出现呼吸功能障碍需要进行气管切开、呼吸机辅助通气分别为31.4%(9/28)和35.7%(10/28)。恶性肿瘤患者术后呼吸功能异常率较良性肿瘤高。结论 延髓恶性肿瘤术后常出现呼吸功能障碍,术后保留气管导管,尤其是经鼻气管插管,有助于术后呼吸功能管理,必要时进行气管切开术及呼吸机辅助通气。

Abstract:

Objective To investigate the anesthetic management of respiratory function in patients with medulla oblongata tumor in the perioperative period.Methods A retrospective analysis was performed on the clinical data of patients with medulla oblongata tumor who were treated by craniotomy in Department of Neurosurgery, Beijing Tiantan Hospital, especially the data on the management of respiratory function during the anesthetic period and perioperative period.Results A total of 28 patients with medulla oblongata tumor from January 2014 to October 2014 were included in the study and the glioma was the most dominating pathology. About 46.4% (13/28) of all patients suffered from swallowing dysfunction and 3.6% (1/28) suffered from respiratory dysfunction before the operation. About 42.8% (12/28) of all patients underwent tracheal intubation via the nose in the operation. Among all the patients, 75% (21/28) received observation with tracheal intubation after the operation, and 31.4% (9/28) and 35.7% (10/28) received tracheotomy and ventilator-assisted ventilation because of respiratory dysfunction after the operation. The patients with malignant tumor were more likely to suffer from respiratory dysfunction than those with benign tumor after the operation.Conclusions The patients with malignant medulla oblongata tumor often suffer from respiratory dysfunction after the operation. Maintaining the intubation, especially the intubation via the nose, is helpful for the management of respiratory function after the operation. And tracheotomy and ventilator-assisted ventilation should be performed if necessary.