颈椎手术的麻醉及其管理

Anesthesia and Management for Cervical Vertrbrae Surgery

目的:总结36例颈椎手术麻醉处置。方法:术前依据颈椎病变压迫脊髓程度及全身状况等变化,给予颅骨牵引,颈托固定,抗炎、脱水等治疗。采用静吸复合麻醉,气管插管控制呼吸,给颈前或颈后入路行病变椎体次全切除、自体髂骨植骨内固定术。21例术中行短潜伏期感觉诱发电位(SLSEP)监测。结果:SLSEP监测 3例 P25潜伏期在术中略有延长,33例术毕15min内苏醒,术后 3例留置气管导管 2h～5h,36例均愈后良好,无麻醉并发症。结论:完善的术前准备,气管插管轻柔操作,密切监测SLSEP,可安全完成该类手术的麻醉。

To summarized the management of anesthesia for 36 patients undergoing vertebrae procedure. Methods: According to preoperative degree of cervical spinal cord compression and general status of patients, cephalic traction, cervical fixation, anti-inflammation and dehydrate were implemented. All patients were treated with vertebrae subtotal excision and self-iliac bone graft and cervical spine fixation under intravenous-inhalant anesthesia. Tracheal intubation was performed for mechanical ventilation during anesthesia. The somatosensory evoked potentials (SLSEP) were recorded intraoperatively in 21 patients. Results: The SLSEP results suggested latency of P25 increased in 3 cases, but no further neurological deficits founded postoperatively. 33 patients were awake within 15 minutes after operation. Tracheal intubation was remained 2-5 hours in 3 patients after operation. All 36 patients had good recovery without anesthesia complication. Conclusion: Well preparation, elegant intubation and SLSEP monitoring should need to finish the anesthesia for cervical vertebrae surgery safely.