Boysen P G
Department of Anesthesiology, University of Florida College of Medicine, Gainesville.
Clin Chest Med. 1993 Jun;14(2):321-33.
The perioperative management of the thoracotomy patient must be both specific and flexible. The assessment of preoperative information yields information as to operability and resectability. Once anesthesia is administered for operative procedures, however, techniques and methods must be changed to accommodate additional information obtained during the surgical procedure. The preoperative and intraoperative management is focused on improving pulmonary function during the postoperative period and improving outcome. Significant advances in pain management techniques have evolved within the last 10 to 15 years. Relieving the intense pain associated with a thoracotomy incision not only improves patient well-being, but improves breathing patterns and pulmonary function, resulting in a more comfortable and ambulatory patient. Epidural analgesia, intrathecal analgesia, intrapleural installation of local anesthetics, and PCA are but a few of the techniques that enhance the therapeutic armamentarium and improve the postoperative course. Inasmuch as surgical extirpation of lung cancers remains the best hope of survival for many patients, a detailed and aggressive management plan is necessary to achieve the desired result.
开胸手术患者的围手术期管理必须既具针对性又有灵活性。术前信息评估可得出关于手术可行性和可切除性的信息。然而，一旦为手术操作实施麻醉，就必须改变技术和方法，以适应手术过程中获取的更多信息。术前和术中管理的重点是在术后改善肺功能并提高治疗效果。在过去10到15年里，疼痛管理技术有了显著进展。缓解与开胸手术切口相关的剧痛不仅能改善患者的舒适度，还能改善呼吸模式和肺功能，使患者更舒适且能更自如地活动。硬膜外镇痛、鞘内镇痛、胸膜腔内注射局部麻醉药以及患者自控镇痛等只是增强治疗手段并改善术后进程的部分技术。鉴于手术切除肺癌仍是许多患者生存的最大希望，制定详细且积极的管理计划对于实现预期效果至关重要。
