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晚期恶性肿瘤患者23例,ASAⅡ或Ⅲ级,在静脉全麻下采用红外线辐射体表加热实施全身热疗(WBH),包括升温期(食管下段温度达41．8℃)、恒温期(维持41．8℃恒温1 h)及降温期(开舱自然降温,体温降至38．5℃)。有创监测血液动力学、呼吸力学、肺氧合指标,测定电解质、血糖和尿量。升温期和恒温期心率、心脏指数、每搏指数、中心静脉压、平均肺动脉压、肺动脉楔压、肺内分流率和气道峰压升高,平均动脉压、动脉血二氧化碳分压、动脉血pH、BE、血钾和血糖下降,降温期逐渐恢复。恒温期和降温期低血压和肺水肿发生率较高。采用对循环干扰小的静脉复合全麻,有创监测血液动力学,呼吸支持,及时纠正内环境失衡,维持心肺功能稳定,保护重要脏器的功能,是WBH麻醉处理的关键。
Twenty-three patients with advanced malignant tumors, ASA II or III, underwent generalized thermal hyperthermia (WBH) using infrared radiation surface heating under venous general anesthesia, including a temperature increase period (the lower esophageal temperature reached 41.8°C) and a constant temperature period (maintaining 41 .8°C constant temperature for 1 h) and cooling period (natural temperature drop in the cabin, body temperature dropped to 38.5°C). Invasive monitoring of hemodynamics, respiratory mechanics, pulmonary oxygenation, determination of electrolytes, blood glucose, and urine output. Heart rate, cardiac index, stroke index, central venous pressure, mean pulmonary artery pressure, pulmonary wedge pressure, intrapulmonary shunt rate and peak airway pressure during the warming and constant temperature periods, mean arterial pressure, arterial blood carbon dioxide pressure, arterial blood pH , BE, serum potassium, and blood glucose decreased, and the cooling period gradually recovered. The incidence of hypotension and pulmonary edema was higher in the constant temperature and cooling periods. The key to WBH anesthetic treatment is the use of intravenous combined general anesthesia with minimal disturbance to the circulation, invasive monitoring of hemodynamics, respiratory support, timely correction of internal environmental imbalances, maintenance of stable heart and lung function, and protection of vital organs.