经皮射频消融治疗复杂弥漫性动静脉畸形围术期麻醉处理

目的:探讨复杂弥漫性动静脉畸形经皮射频消融术的麻醉特点及围术期处理。方法:2014年12月—2018年12月临沂市肿瘤医院血管瘤淋巴瘤科经皮射频消融治疗复杂弥漫性动静脉畸形38例,其中颌面颈部28例(伴张口困难6例,睡眠时打鼾8例),躯干部6例,下肢4例。所有患者采用静吸复合麻醉,在彩超实时监视下进行消融。观察患者诱导前、消融后30、60、90 min及术后6 h的血流动力学、体温、尿液及相关并发症。结果:无困难气道插管顺利患者20例(52.7%),可视喉镜探查插管8例(21.1%),可视光棒或纤支镜插管5例(13.1%),预防性气管切开5例(13.1%)。消融后30、60、90 min,患者体温、血压、心率升高明显(P<0.05),2例患者2次治疗后出现高热(5.3%),5例患者术后出现一过性血红蛋白尿(13.2%),6例患者术后出现恶心呕吐(15.8%),3例患者出现全身不适伴寒颤(7.9%)。随访1~3年,38例(100%)获得Ⅲ、Ⅳ级的治疗效果。结论:射频消融治疗复杂弥漫性动静脉畸形效果确切,准确掌握定位穿刺及消融技巧,加强血流动力学、体温、血红蛋白尿监测,是围术期麻醉处理的关键。

Percutaneous radiofrequency ablation for complex diffuse arteriovenous malformations during perioperative anesthesia

Objective:To explore the anesthetic characteristics and management of percuta neous radiofrequency ablation of complex diffuse arteriovenous malformations.Methods:The clinical data of 38 patients with hemangioma treated by percutaneous radiofrequency ablation in Linyi Cancer Hospital from December 2014 to December 2018 were retrospectively analyzed.Among them,28 cases of maxillofacial(There were 6cases with difficulty in opening mouth,8 cases with snoring during sleep),6 cases of trunk and 4 cases of lower extremity,All patients were treated with intravenous inhalation combined anesthesia and ablation under real-time monitoring by color Doppler ultrasound.The hemodynamics,body temperature,urine volume,urine color and related complications were recorded before guided,30 min,60 min,and 90minafter ablation and 6 h after operation.Results:20 cases(52.6%)were intubated by rapid induction,8 cases(28.6%)of rapid intubation by visual laryngoscope,and 5 cases(17.9%)by visuallight rod or fiberoptic bronchoscope intubation.The body temperature,blood pressure and heart rate of the patients increased significantly in 30 min,60 min and 90 min after ablation(P<0.05).Two patients had high fever after the first two treatments and five patients had transient hemoglobinuria after operation.Six patients had nausea and vomiting after operation and three patients developed general discomfort and shivering.Follow-up of 1~3 years,38 cases(100%)obtained theⅢ,Ⅳsatisfactory therapeutic effect.Conclusion:Radiofrequency ablation is effective in the treatment of complex and intractable arteriovenous malformations.The key to the management of anesthesia and perioperative period is to accurately grasp the skills of localization puncture and ablation,and to strengthen the monitoring of body temperature,urine volume and urine color during operation.