慢性鼻-鼻窦炎伴鼻息肉围术期哮喘急性发作的原因分析与处理

Causes analysis and treatments of acute asthma attack during the perioperative period in chronic rhinosinusitis with nasal polyps

目的分析慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者围术期哮喘急性发作的原因及抢救措施。方法回顾性分析2011年2月~2018年1月我科9例CRSwNP患者围术期哮喘急性发作的临床病例资料,对其发病原因及抢救措施进行总结分析。结果9例患者入院后进行气道评估及干预后肺功能均达到手术标准。哮喘急性发作于术中3例,术后6例。9例患者经过高流量吸氧、β2受体激动剂、布地奈德混悬液及肾上腺素等雾化吸入,和/或甲强龙、茶碱类、抗感染等药物联合应用,联合麻醉科、变态反应科、重症医学科等多学科抢救后均控制良好。结论CRSwNP患者围术期相关危险因素可能诱发哮喘急性发作,加强围术期气道管理将有效降低哮喘急性发作,多学科联合救治最大程度降低死亡率。

OBJECTIVE To analyze the causes and rescue measures of acute attack of asthma during the perioperative period in chronic rhinosinusitis with nasal polyps(CRSwNP).METHODS Clinical data of 9 cases of CRSwNP with acute asthma occurred during the perioperative period were analyzed retrospectively from February 2011 to January 2018 in our department.The causes and the rescue measures were summarized and analyzed.RESULTS The lung function of 9 patients achieved the standard of operation by airway assessment and intervention after admission.There were 3 cases of acute episode of asthma during the operation,6 cases of asthma attack after operation.All episodes were treated immediately with high flow oxygen,aerosol inhalation ofβ2 receptor agonist,budesonide suspension and epinephrine combined with methylprednisolone,theophylline,anti-infection drugs,et al.Asthma was well controlled through multi-disciplinary treatments,including anesthesiology department,allergy department,intensive care unit and other disciplines.CONCLUSION Perioperative risk factors may induce acute asthma attacks in CRSwNP.Strengthening perioperative airway management will effectively prevent acute asthma attack,and multi-disciplinary treatment can minimize mortality.