脊柱侧凸患者的围手术期管理

Perioperative management of the patient with scoliosis in spine surgery

脊柱侧凸是一种脊柱三维畸形,随病情进展可明显影响患者心肺功能、活动能力,出现脊髓受压甚至瘫痪。严重脊柱侧凸常需手术矫正,而脊柱侧凸矫正手术难度大、时间长、出血多,甚至需分期手术。部分患者同时合并其他系统先天性疾病。故此类患者围手术期管理难度较大。文章结合新近研究进展,剖析脊柱侧凸患者低体重、困难气道、肺功能受损等特点,以及常见脊柱松解、胸廓成形、脊柱截骨矫形、切口深部感染清创等手术特点,阐明困难气道处理、术中监测、通气策略、容量管理、术后镇痛等围手术期管理重点,为临床工作提供参考。

Scoliosis is a three-dimensional deformity of the spinal column.With the development of the disease,patients may suffer from cardiopulmonary function impairment,multifunctional limitation,spinal cord compression,to even paralysis.Severe scoliosis requires surgical correction.The spinal deformity correction is a high-risk procedure,with a long operative time,massive blood loss,and the possibility of multiple surgeries.Some patients are comorbined with congenital disease.Thus,perioperative management for these patients is very challenging work.This article aims to review the characteristics of patients with scoliosis(including low body weight,difficult airway,and impaired cardiopulmonary function),different surgical procedures(including spinal release,thoracoplasty,spinal fusion and correction,and debridement),and the focus of perioperative management(including airway management,intraoperative monitoring,fluid therapy,ventilation and analgesic strategies),to provide valuable references for clinical work.