脊柱外科术后并发应激性溃疡5例临床病例分析

Clinical case study of 5 cases of postoperative stress ulcers complicated by spinal surgery

目的 探讨脊柱外科术后并发应激性溃疡(SU)的相关因素及预防措施。方法 对脊柱外科行全身麻醉(全麻)手术后并发SU的5例患者的临床资料进行回顾性分析。结果 5例患者中, 2例患者给予胃肠减压、止血药物、质子泵抑制剂、保护胃黏膜等保守治疗后病情逐渐控制,粪便常规检查大便隐血试验阴性。1例患者因急腹症行十二指肠溃疡穿孔修补术治疗,手术后康复出院。2例患者因持续血红蛋白降低,给予输血、胃肠减压、应用止血药物、质子泵抑制剂、保护胃黏膜等治疗,病情加重后转入重症加强护理病房(ICU)进一步抢救治疗,但病情危重,因失血性休克死亡。结论 脊柱外科全麻术后并发SU是一种严重并发症,对长期服用非甾体类消炎药物、糖皮质激素、隐匿性消化道溃疡、高龄等患者围手术期应预防性使用胃黏膜保护剂及抑制胃酸分泌药物以防止SU的发生。

Objective To investigate the related factors and preventive measures of postoperative stress ulcers(SU)complicated by spinal surgery.Methods The clinical data of 5 patients with complicated SU after general anesthesia in spine surgery were retrospectively analyzed.Results Among the 5 patients,2 patients were gradually controlled after conservative treatment such as gastrointestinal decompression,hemostatic drugs,proton pump inhibitors,and protection of gastric mucosa,and routine fecal exams showed negative results in fecal occult blood test.1 patient was treated with repair of duodenal ulcer perforation due to acute abdomen,and was discharged from hospital after recovery.2 patients were given blood transfusion,gastrointestinal decompression,hemostatic drugs,proton pump inhibitors,protection of gastric mucosa and other treatments due to persistent hemoglobin decrease.After the condition worsened,they were transferred to intensive care unit(ICU)for further rescue treatment,but their condition was critically ill and they died due to hemorrhagic shock.Conclusion Complicated stress ulcers after general anesthesia in spine surgery are a serious complication.Gastric mucosal protective agents and drugs to inhibit gastric acid secretion should be used prophylactically to prevent the occurrence of SU during the perioperative period in patients taking long-term nonsteroidal anti-inflammatory drugs,glucocorticoids,occult peptic ulcers,and advanced age.