神经外科患者围手术期紧急困难气道抢救10例临床分析

摘要

目的:回顾神经外科患者围手术期发生紧急困难气道病例的临床特点,分析发生紧急气道原因及抢救经验和教训.方法:回顾性分析首都医科大学宣武医院神经外科2010年1月至2014年12月治疗围手术期发生紧急困难气道情况需要进行抢救的患者,对原发病、紧急气道情况、抢救措施、治疗结果及远期预后进行分析.结果:10例患者发生紧急困难气道危险,男6例,女4例,原发病主要为颈部及枕颈交界区病变,包括寰枢椎脱位合并颅底凹陷、头颈部外伤、颈动脉内膜切除术后及颈部血管畸形等.发生紧急困难气道危险的主要首发临床表现常为烦躁不安、呼吸急促、憋气,发生颈部血肿患者可见局部肿胀、气道偏斜、血氧下降、三凹征等.紧急救治方法主要包括:紧急气管插管、经皮气管切开、床旁血肿清除或急诊手术血肿清除.随访6月至5年,9例预后良好,1例因合并心跳骤停、缺血缺氧性脑病植物生存.结论:神经外科手术尤其是头颈、颅底、颈部血管手术的围手术期需强调气道管理,术前充分判断气道风险,对出现不明原因烦躁、急性呼吸困难患者,须警惕紧急困难气道.正确判断,及时采取最熟悉的方法予以积极治疗,方可减少并发症,改善预后.%Objective:To analyze clinical characteristics of difficult airway cases preoperatively in the neurosurgery department,and to study reasons for difficult airway and summarize the experiences achieved.Methods:Patients with perioperatively difficult airways and advanced airway management were retrospectively analyzed during Jan 2010 to Dec 2014 admitted in neurosurgery department of Xuanwu Hospital affiliated to Capital Medical University.We focused on the original diseases,difficult airway situation,rescue managements,treatment effect and long-term prognosis.Results:A total of 10 cases of patients showed emergent difficult airway preoperatively,6 males and 4 females respectively.The original diseases were mainly located in the cervical segments or cranio-cervical junction region,including atlanto-occipital dislocation accompanied with basilar invagination,traumatic brain and cervical injury,post cervical endarterectomy and post cervical AVM resection etc.The most common initial symptoms included dysphoria,tachypnea and difficulty in breathing.Cases with cervical incision hematoma usually presented with local swelling,tracheal deviation,tri-retraction sign accompanied with oxygen desaturation.The rescue managements included urgent trachea intubation,percutaneous tracheotomy,hematoma drainage at ICU bedside and urgent removal of hematoma in the operation room.Six-month to 5-years follow-up showed that 9 cases had good recoery,and 1 patient was in the persistent vegetative state after hypoxic ischemic encephalopathy caused by cardiac arrest.Conclusion:Airway management should be paid much attention in perioperative patients of neurosurgery department,especially for the surgery area located near neck,the skull base and cervical vessels.Special care should be taken on patients with unexplained irritability,shortness of breath whom were likely to develop difficult airways.Early correct diagnosis and timely rescue management using experienced methods are the key for reducing fetal complications and improving prognosis.