上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (7): 774-.doi: 10.3969/j.issn.1674-8115.2019.07.015

• 论著·临床研究 • 上一篇    下一篇

选择性眼动脉介入化疗术治疗视网膜母细胞瘤的麻醉管理

方舒东，支延康，周驰，孙宇，姜虹   

  1. 上海交通大学医学院附属第九人民医院麻醉科，上海 200011
  • 出版日期:2019-07-28 发布日期:2019-08-26
  • 通讯作者: 支延康，电子信箱：shanghaidakang@126.com。
  • 作者简介:方舒东（1972—），男，主治医师，博士；电子信箱： drfangshudong@163.com。

Anesthesia management of selective ophthalmic intra-arterial chemotherapy for retinoblastoma

FANG Shu-dong, ZHI Yan-kang, ZHOU Chi, SUN Yu, JIANG Hong   

  1. Department of Anesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Online:2019-07-28 Published:2019-08-26

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摘要： 目的 ·评价全麻下行眼动脉介入化疗治疗视网膜母细胞瘤（ retinoblastoma，RB）的临床安全性。方法 ·收集自 2015年 9月至 2018年 8月于上海交通大学医学院附属第九人民医院在全麻下行眼动脉介入化疗的 RB患儿 60例，麻醉诱导采用咪达唑仑、芬太尼、丙泊酚、罗库溴铵快诱导气管插管，术中予以七氟醚和氧气麻醉维持，间断推注罗库溴铵和芬太尼。术中持续监测血液动力学参数、呼吸参数（ EtCO2、氧饱和度和吸气峰压）、七氟醚最低肺泡有效浓度（ minimum alveolar concentration，MAC），观察记录术中肺顺应性、低氧血症、低血压等不良心肺事件。结果 · 3年间 60名患者共进行了 185次介入化疗。在 20名患者中观察到 32次心肺不良事件，发生率为 17.2％，包括肺顺应性严重下降、低氧血症、动脉低血压等。肺顺应性严重下降发生在导管插入眼动脉后 1～ 2 min。应用异丙酚、苯肾上腺素、肾上腺素等积极治疗后恢复正常，无死亡及永久性后遗症。结论 ·在 RB患者行眼内动脉输注化疗术中，三叉神经反射发生率较高。麻醉医师和介入医师都应该意识到这一潜在事件，并准备好立即抢救复苏的措施。

关键词: 眼动脉, 动脉介入化疗, 视网膜母细胞瘤, 儿童麻醉

Abstract:

Objective · To investigate the safety of treatment with ophthalmic artery cannulation for intra-arterial chemotherapy (IAC) in children with retinoblastoma (RB) during general anesthesia. Methods · A total of 60 children with RB who underwent ocular artery interventional chemotherapy under general anesthesia in Shanghai Ninth Peoples Hospital, Shanghai Jiao Tong University School of Medicine September 2015 to August 2018 were collected. Induction of anesthesia was performed with rapid induction of endotracheal intubation with midazolam, fentanyl, propofol and rocuronium. Sevoflurane and oxygen were administered for maintenance of general anesthesia, with intermittent injection of rocuronium and fentanyl. Intraoperative continuous monitoring of hemodynamic parameters, respiratory parameters (EtCO2, oxygen saturation and inspiratory peak pressure) and sevoflurane minimum alveolar concentration (MAC) was performed, and intraoperative pulmonary compliance, hypoxemia, hypotension and other cardiopulmonary adverse events were observed and recorded. Results · Over a 3-year period, 185 treatment sessions were performed in 60 patients. Thirty-two cardiopulmonary adverse events were observed in 20 patients, and the incidence rate was 17.2%, mainly including severe decrease in lung compliance, hypoxemia and arterial hypotension. All severe decreases in lung compliance occurred within 1 or 2 minutes after catheter insertion in the ophthalmic artery. After active treatment with propofol, phenylephrine and epinephrine, no death and permanent sequelae occured. Conclusion · An appreciable incidence of trigeminocardiac reflex to intra-ophthalmic artery infusion of chemotherapy in patients with RB is found. Both interventionalists and anesthesiologists should be aware of this potential event and be prepared to provide immediate resuscitative measures.

Key words: ophthalmic artery, intra-arterial chemotherapy, retinoblastoma, pediatric anesthesia

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