脊柱肿瘤后路全脊椎整块切除并脊柱重建术中风险预警分析及护理对策

Risk analysis and nursing for spinal tumor patients during total en bloc spondylectomy and spine reconstruction

目的回顾性总结6例脊柱肿瘤患者行一期后路全脊椎整块切除手术（TES）的术中风险因素，进行相应风险预警，制定护理对策。方法2014年9月—2016年9月郑州大学第一附属医院骨科共6例脊柱肿瘤患者行一期TES＋椎弓根钉系统固定手术。针对术中易出现的脊髓神经损伤、大出血、肿瘤细胞种植转移、感染等高风险因素，采取的护理干预措施包括保护脊髓功能、术中血压控制、严格手术隔离技术、蒸馏水及稀释聚维酮碘溶液浸泡术野等。结果本组手术均顺利完成，所有患者恢复良好，未发生医源性脊髓神经损伤、重要血管损伤、感染等并发症。术后随访12~36个月，疗效满意，未出现局部肿瘤复发。结论对术中风险的正确预警和护理干预对TES患者的手术顺利进行有重要作用，能有效地减少并发症的发生。

Objective To retrospectively summarize the risk factors in 6 spinal tumor patients during primary total en bloc spondylectomy （TES）, to give risk warning, and to propose nursing countermeasures. Methods Totally 6 spinal tumor patients received primary TES and transpedicular screw system fixation in the First Affiliated Hospital of Zhengzhou University between September 2014 and September 2016. In responseto high risk factors such as spinal cord injury, massive hemorrhage, tumor cell planting and metastasis and infection as seen in the operation, nursing interventions included protecting spinal cord function, intraoperative blood pressure control, strict surgical isolation techniques, and soaking surgery field with distilled water and diluted povidone-iodine solution. Results The operation for the 6 patients were completed successfully, and all patients recovered well, without any complication such as iatrogenic spinal cord injury, important blood vessel injury or infection. It was found in the 12 to 36-month follow-up visits that the efficacy was satisfying, without local neoplasm recurrence. Conclusions Proper warning and nursing interventions against intraoperative risks make significant contributions to the smooth operation of spinal tumor patients during TES and reduce the incidence of complications effectively.