Gross M L, Schwedler M, Bischoff R J, Kerstein M D
Tulane University School of Medicine, New Orleans, Louisiana.
Am Surg. 1993 Apr;59(4):261-4.
Fifty-two surgical procedures were performed on 45 patients with sickle cell anemia. All patients were managed perioperatively with hydration and were kept warm and well oxygenated. Patients were anesthetized with either halothane (n = 16), enflurane (n = 22), isoflurane (n = 6), or intravenous narcotics (n = 4). Four patients had epidural anesthesia. Perioperative morbidity was assessed using the criteria of atelectasis, urinary tract infection, wound infection, thrombophlebitis, drug reaction, hypotension, and vaso-occlusive crisis. The overall perioperative complication rate in this study was 45 per cent. Patients anesthetized with isoflurane and enflurane had postoperative morbidity rates of 83 and 59 per cent, respectively, while the patients anesthetized with halothane had a complication rate of 25 per cent. In all three groups, atelectasis was the main cause. No complications occurred in the epidural group. In the intravenous anesthesia group, one patient developed sickle cell crisis. It appears that the types of anesthetic agents used do not impact on postoperative morbidity in patients with sickle cell anemia more than any other type of patient.
对45例镰状细胞贫血患者实施了52例外科手术。所有患者在围手术期均接受补液治疗，并保持温暖和充分的氧合。患者分别接受氟烷麻醉（n = 16）、恩氟烷麻醉（n = 22）、异氟烷麻醉（n = 6）或静脉麻醉药麻醉（n = 4）。4例患者接受了硬膜外麻醉。采用肺不张、尿路感染、伤口感染、血栓性静脉炎、药物反应、低血压和血管闭塞性危象等标准评估围手术期发病率。本研究的总体围手术期并发症发生率为45%。接受异氟烷和恩氟烷麻醉的患者术后发病率分别为83%和59%，而接受氟烷麻醉的患者并发症发生率为25%。在所有三组中，肺不张是主要原因。硬膜外麻醉组未发生并发症。在静脉麻醉组中，1例患者发生镰状细胞危象。看来，与其他类型的患者相比，镰状细胞贫血患者使用的麻醉剂类型对术后发病率并无更大影响。
