CAJ | 학술논문

目的：探讨不同麻醉方式在经皮射频消融(RFA)治疗肝癌时的安全性及麻醉效果。方法收集2010年1月—2014年10月期间102例行经皮肝癌RFA治疗患者的临床资料进行回顾性分析,根据所选用麻醉方法的不同分为3组,A组,采用控制呼吸静脉全麻组；B组,采用静脉全麻保留自主呼吸组；C组,采用局部麻醉监护组。比较治疗前后患者的生命体征、围手术期不良反应及手术并发症的情况。结果 A、B组手术操作时间均多于C组(P＜0.02)；术后A组较B组苏醒时间长(P＜0.03)；RFA术中A、B两组患者的生命体征均较C组平稳(P＜0.01)；A、B组患者术中血氧饱和度均能维持在95％以上,从放置氧气面罩至手术结束时,B组较A组低(P＜0.05),C组患者较A、B组均低(P＜0.01)；A组患者术中体动、流泪以及需麻醉机辅助呼吸等不良反应发生率明显低于B、C组(P＜0.01)。 B、C组术中及术后并发症如皮下气肿、气胸或术后行胸腔闭式引流发生率等情况均高于A组(P＜0.05)。结论肝癌RFA应用静脉全身麻醉能够减少手术时间,为患者营造了一个安全、舒适的手术环境。其中控制呼吸静脉全身麻醉组安全性较高、围手术期不良反应及手术并发症的发生率较低,可能是肝癌RFA治疗的一种相对较好的麻醉方式。
목적：탐토불동마취방식재경피사빈소융(RFA)치료간암시적안전성급마취효과。방법수집2010년1월—2014년10월기간102례행경피간암RFA치료환자적림상자료진행회고성분석,근거소선용마취방법적불동분위3조,A조,채용공제호흡정맥전마조；B조,채용정맥전마보류자주호흡조；C조,채용국부마취감호조。비교치료전후환자적생명체정、위수술기불량반응급수술병발증적정황。결과 A、B조수술조작시간균다우C조(P＜0.02)；술후A조교B조소성시간장(P＜0.03)；RFA술중A、B량조환자적생명체정균교C조평은(P＜0.01)；A、B조환자술중혈양포화도균능유지재95％이상,종방치양기면조지수술결속시,B조교A조저(P＜0.05),C조환자교A、B조균저(P＜0.01)；A조환자술중체동、류루이급수마취궤보조호흡등불량반응발생솔명현저우B、C조(P＜0.01)。 B、C조술중급술후병발증여피하기종、기흉혹술후행흉강폐식인류발생솔등정황균고우A조(P＜0.05)。결론간암RFA응용정맥전신마취능구감소수술시간,위환자영조료일개안전、서괄적수술배경。기중공제호흡정맥전신마취조안전성교고、위수술기불량반응급수술병발증적발생솔교저,가능시간암RFA치료적일충상대교호적마취방식。
Objective To evaluate the safety and effectiveness of different anesthesia methods in performing percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). Methods The clinical data of 102 HCC patients, who were admitted to authors’ hospital during the period from January 2010 to October 2014 to receive percutaneous RFA, were retrospective analyzed. According to the anesthesia method used for RFA, the patients were divided into 3 groups. Group A: control of breathing and general intravenous anesthesia; group B: general intravenous anesthesia with spontaneous breathing; group C: local anesthesia with monitoring. The vital signs, perioperative adverse reactions and procedure-related complications were analyzed. Results The operation time of group A and B was longer than that of group C (P<0.02); the time of waking up after the operation in group A was longer than that in group B (P<0.03). During the performance of RFA the patient’s vital signs in group A and B were more stable than those in group C (P<0.01);during the performance of RFA the blood oxygen saturation in patients of both group A and B remained above 95%(from the placement of oxygen masks to the end of operation), although the blood oxygen saturation of group B was lower than that of group A (P<0.05), and the blood oxygen saturation of group C was lower than that of both group A and B (P<0.01). The incidences of adverse reactions such as involuntary limb activity, tears, need of anesthesia machine-assisted respiration, etc. in group A were significantly lower than those in group B and C (P<0.01). The postoperative complications such as subcutaneous emphysema, pneumothorax or need of thoracic drainage in group B and C were significantly higher than those in group A (P<0.05). Conclusion General intravenous anesthesia can reduce the operation time of RFA for HCC, which can create a safe and comfortable surgical environment for patients. The use of general intravenous anesthesia together with the control of breathing is the safest method with lower incidence of perioperative adverse reactions and procedure-related complications; it might be a relatively optimal anesthesia method for RFA of HCC.