腰椎退变性疾病行内固定手术的麻醉处理

Anesthesia Treatment in Internal Fixation Surgery for Lumbar Vertebra Cataplasia Diseases

目的探讨腰椎退变性疾患行内固定手术的麻醉处理的特殊性。方法回顾性总结近年来腰椎退变性疾患行内固定手术的麻醉患者364例,术前重点了解有否严重伴随疾病,并作相应的术前准备,选择合适的麻醉方法,必要的监测手段。结果9例病窦综合征和严重房室传导阻滞者,术前先放临时起搏器,再行脊柱手术。96例患者直接选用气管插管全麻;268例选择连续硬膜外麻醉,其中43例硬膜外阻滞,由于麻醉平面不够,扩散欠佳,不能手术而改气管插管全麻。行自体血回输291例,回输自体血250～1 200 ml,平均550 ml;291例中输异体血82例,输血量200～600 ml,平均400 ml;未行自体血回输73例,输异体血600～2 000,平均1 000 ml,两者比较有显著性差异(P<0.01);无一例因麻醉出现严重并发症。结论腰椎退变性疾患行内固定手术,应积极治疗伴随疾病,选择合理的麻醉方法,必要时行自体血回输,术中严密监测,防止脊髓继发性损伤发生,是提高手术麻醉安全性的重要措施。

Objective To discuss the specifieness of anesthetic treatment in internal fixation surgery for lumbar vertebra cataplasia diseases. Methods Retrospective summarization was done in 364 patients with lumbar vertebra cataplasia diseases experiencing anesthesia for internal fixation surgery in the recent years. We gathered the messages about serious concomitance diseases from the patients, and did proportional preoperative preparation including the selection of suitable anesthesia method and essential monitoring means. Results Nine patients suffering sick sinoatrial node syndrome and severe A-V block were placed temporary, cardiac pacer before anesthetize. Of the patients, 96 adopted endotracheal intubation and general anaesthesia directly： 268 adopted continuous epidural anesthesia, but 43 of them turned to endotracheal intubation and general anaesthcsia because of not getting the good depth of anaesthesia. Autoblood transfusion was given to 291 patients （250 - 1 200 ml, average = 550 ml） , and 82 of them were additionally given allogenic blood transfusion （200 -600 ml, average = 400 ml）. Undo-autoblood-transfusion was done in 73 patients who received the therapy of allogenic blood transfusion （600 -2 000 ml, average = 1 000 ml）. To compare tbe allogenic blood transfusion volume, we saw significant difference （P 〈0. 01 ）. None of them suffering serious concurrent diseases. Conclusion The patients suffering lumbar vertebra eataplasia disease, who are due to be performed internal fixation surgery, should be treated for the concomitance diseases. The surgeons should select suitable anesthesia method, administer autoblood transfusion to the patients when it is necessary, monitor rigorously in surgery, and prevent secondary injury of spinal cord. All these can raise the safety of anesthesia.