强直性脊柱炎后凸畸形截骨矫形术患者术后麻醉重症监护病房监测治疗30例分析

The monitoring and treatment of 30 patients after kyphosis osteotomy surgery for ankylosing spondylitis in AICU

目的总结强直性脊柱炎(AS)后凸截骨矫形手术术后麻醉重症监护病房(AICU)监测治疗经验。方法以行AS后凸截骨矫形术术后转入AICU患者(30例)为研究对象,对患者一般资料、术中指标(困难气道发生率、术中出血量、手术时长等)及术后转入AICU情况(肺部超声评估、气胸发生率、术后机械通气时间、术后疼痛评分、躁动、谵妄发生率等)进行总结。结果30例患者ASAⅢ级17例(57%),困难气道行清醒插管11例(37%),患者术后入AICU后即刻超声下评估,肺部出现B线(包括双上下肺或双下肺)患者25例(83.33%);6例(20%)患者发现气胸;机械通气时间中位数为2.88(1.79,4.00)h;术后24 h内疼痛评分(VAS)均<3分;无患者发生术后躁动;AICU期间1例(3.33%)患者发生术后谵妄,AICU停留时间为1(1,1.25)d,所有患者停留AICU时间均未超过48 h,所有患者均在术后早期拔出了气管导管,无再插管情况;所有患者转出AICU时床旁肺部超声均未见B线。结论AS后凸截骨矫形手术危重症患者术后转入AICU监护治疗可以实现危重症患者早期拔除气管导管,早期预防及治疗相关并发症,有利于患者术后快速康复。

Objective To summarize the experience of monitoring and treatment in AICU after kyphosis osteotomy surgery for ankylosing spondylitis.Methods Thirty patients transferred to AICU after kyphosis osteotomy surgery for ankylosing spondylitis were studied.General patients information,intraoperative indicators,including incidence of difficult airway,amount of intraoperative bleeding,operation time and etc.,and indicators of postoperative transfer to AICU,including pulmonary ultrasound evaluation,incidence of pneumothorax,postoperative mechanical ventilation time,postoperative pain score,incidence of agitation,and incidence of delirium etc.,were summarized.Results Seventeen patients were ASA GradeⅢ(57%),and 11 patients(37%)received conscious endotracheal intubation due to difficult airway.The lung condition of patients who transferred to AICU was evaluated by ultrasound.There were 25 patients(83.33%)with B-line in the lung(including both upper and lower lungs or both lower lungs).Pneumothorax was found in 6 patients(20%).The median duration of mechanical ventilation was 2.88 hours(1.79 hours,4.00 hours).The pain score(VAS)within 24 hours after operation was less than 3.The incidence of postoperative agitation was 0(0%).One patient(3.33%)developed postoperative delirium during AICU.The median AICU stay was 1 day(1 day,1.25 days).All patients did not stay in AICU for more than 48 hours.All endotracheal tubes were extubated as soon as possible after operation,and there was no reintubation.No B-line was found in bedside lung ultrasound when all patients were transferred out.Conclusion Patients in critical condition after osteotomy and orthopedic surgery for ankylosing spondylitis can be transferred to AICU for monitoring and treatment,preventing early treatment-related complications,and facilitate the rapid postoperative recovery.