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手术治疗脊柱转移瘤时应用控制性降压。

Application of Controlled Hypotension During Surgery for Spinal Metastasis.

机构信息

74768Tianjin Hospital, Tianjin, China.

Graduate School, 12610Tianjin Medical University, Tianjin, China.

出版信息

Technol Cancer Res Treat. 2022 Jan-Dec;21:15330338221105718. doi: 10.1177/15330338221105718.

DOI:10.1177/15330338221105718
PMID:35668701
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9178972/
Abstract

With advances in tumor treatment, metastasis to bone is increasing, and surgery has become the only choice for most terminal patients. However, spinal surgery has a high risk and is prone to heavy bleeding. Controlled hypotension during surgery has outstanding advantages in reducing intraoperative bleeding and ensuring a clear field of vision, thus avoiding damage to important nerves and vessels. Antihypertensive drugs should be carefully selected after considering the patient's age, different diseases, etc, and a single or combined regimen can be used. Hypotension also inevitably leads to a decrease in perfusion of important organs, so the threshold of hypotension and the maintenance time of hypotension should be strictly limited, and the monitoring of important organs during the operation is particularly important. Information such as blood perfusion, blood oxygen saturation, cardiac output, and neurophysiological conduction potential changes should be obtained in a timely fashion, which will help to reduce the risk of hypotension. In short, when applying controlled hypotension, it is necessary to choose an appropriate threshold and duration, and appropriate monitoring should be conducted during the operation to ensure the safety of the patient.

摘要

随着肿瘤治疗的进展,骨转移的发生率逐渐增高,手术成为大多数终末期患者的唯一选择。但脊柱手术风险较高,易发生大出血。术中控制性降压在减少术中出血、保证术野清晰方面具有突出优势,从而避免对重要神经、血管的损伤。降压药物的选择应考虑患者年龄、不同疾病等因素,可采用单一或联合方案。低血压也不可避免地导致重要器官灌注减少,因此应严格限制低血压的阈值和维持时间,术中对重要器官的监测尤为重要。及时获取血灌注、血氧饱和度、心输出量和神经生理传导电位变化等信息,有助于降低低血压风险。总之,应用控制性降压时,需要选择合适的阈值和持续时间,并在术中进行适当的监测,以确保患者的安全。