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1、放射性粒子植入治疗颌面部恶性肿瘤的麻醉处理作者：杨旭东，董稳，张建国作者单位：1•北京大学口腔医院麻醉科;2•颌面外科北京100081【摘要】冃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。结杲LA组患者较TT组和LMA组患者术屮心血管反应剧烈，术屮最低SpO2低于术前且低于T
2、T组和LMA组（PvO.05）；术中休动和疼痛程度高于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）,其屮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
3、子BAnesthesiamanagementforradioactiveseedimplantationintreatmentoforalandmaxillofacialmalignanttumorYANGXu・dongl,DONGWenl,ZHANGJian-guo2.(1.Dept,ofAnesthesiology,SchoolofStomatology,PekingUniversity,Beijing100081,China;2.Dept,ofOralandMaxillofacialSurgery,SchoolofStomato
4、logy,PekingUniversity,Beijing100081,China)[Abstract]ObjectiveToinvestigatecharacteristicsofanesthesiamanagementforradioactiveseedimplantationintreatmentoforalandmaxillofacialmalignanttumor;Methods76patientswithoralandmaxillofacialmalignanttumorreceivingtreatmentofradioa
5、ctiveseedimplantationweregiventhreetypesofanesthesiaaccordingtoindica-tions:Localanesthesiaplusintravenoussedation(groupLA),generalanesthesiawithendotrachealintubation(groupTT)andgeneralanesthesiawithlaryngealmaskairway(groupLMA)・Changesofpatientsfbloodpressure(BP),hear
6、trate(HR)andsaturationofpulseoxygen(SpO2)duringoperationwererecorded.Characteristicsofanesthesiainductionandmaintenanceandperioperativecomplicationswereobserved.ResultsAmongthe76patients,12pa-tientswereenrolledintogroupLA,24patientswereenrolledintogroupTTand40patientswe
7、reenrolledintogroupLMA.PerioperativecardiovascularresponseingroupLAwasmoreintensethanthatingroupTTandgroupLMA(P<0.05).ThelowestSpO2duringoperationofgroupLAwaslowerthanpreoperativevalueandthanthatofgroupTTandgroupLMA(P<0.05).PatientsingroupLAhadmorebodymovementsandmorepa
8、inthanthatingroupTTandgroupLMA(P<0.05).OnepatientofgroupLAhadhypoxemiaduringoperation.IngroupTT,9patientshaddi
