Perioperative airway management for the treatment of atlantoaxial surgical lysis and fixation through transoral approach

目的 探讨经口咽入路寰枢关节松解复位及后路寰枢/枕颈固定术的围手术期的气道管理方法.方法 北京大学第三医院骨科2009年9月至2010年6月行经口咽入路寰枢关节松解复位及后路寰枢/枕颈固定术30例,我们对其采用经口插管并早期拔管(经口组)进行气道管理,并与2008年12月至2009年8月31例行同样手术并采用经皮扩张气管穿刺切开(气切组)进行气道管理的患者进行对比观察,比较人工气道建立至手术开始时间、术后呼吸相关并发症发生率、鼻饲时间、术后住院时间等.结果 经口组人工气道建立至手术开始的时间明显短于气切组[经口组( 39±15) min,气切组(58±16) min,P＜0.01]；经口组术后鼻饲时间明显短于气切组[经口组(6.0±1.2)d,气切组(7.9±0.3)d,P＜0.01]；术后住院时间明显短于气切组[经口组(9.5±1.7)d气切组(11.8±3.4)d,P＜0.01].结论 经口咽入路寰枢关节松解复位及后路寰枢/枕颈固定术围手术期采用经口插管进行气道管理,可避免气管切开相关并发症,在保证临床安全的前提下提高手术室工作效率,缩短术后住院时间.Objective To explore the perioperative airway management for transoral surgical lysis in patients with irreducible atlantoaxial dislocation and posterior atlantoaxial or occipitocervical fixation.Methods Thirty patients undergoing surgical lysis through transoral approach with oral endotracheal intubation (OEI group) between September 2009 and June 2010 were recruited.And another 31 patients underwent transoral surgical lysis from December 2008 to August 2009 with percutaneous dilatational tracheostomy (PDT group).The time interval from artificial airway establishment to start of operation,the duration of nasogastric feeding,the incidence of respiratory complications and the postoperative length of hospital stay were compared between two groups.Results The time interval from artificial airway establishment to the start of operation in the OEI group was significantly shorter than that in the PDT group [ (39±15) vs (58 ± 16) min,P ＜ 0.01 ].The duration for nasogastric feeding in the OEI group was significantly shorter than that in the PDT group [ (6.0 ± 1.2 ) vs ( 7.9 ± 0.3 ) days,P ＜ 0.01 ].And the postoperative length of hospital stay was also shorter in the OEI group than that in the PDT group [ (9.5 ±1.7) vs ( 11.8 ± 3.4 ) days,P ＜ 0.01 ].Conclusion The management of perioperative airway with oral endotracheal intubation may avoid the complications of PDT,improve the utilizing efficiency of operating rooms and shorten the postoperative length of hospital stay.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)0352485-24879