Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.
Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA.
Neurosurgery. 2021 Oct 13;89(Suppl 1):S33-S41. doi: 10.1093/neuros/nyab319.
There are no current recommendations for preoperative pulmonary evaluation and management of patients undergoing elective spine surgery.
The aim of this guideline is to determine preoperative risk factors for perioperative and postoperative pulmonary adverse events and to determine the optimal preoperative evaluation and management of at-risk patients.
A systematic review of the literature was performed using the National Library of Medicine PubMed database and the Cochrane Library for studies relevant to postoperative pulmonary adverse events in patients undergoing spine surgery. Clinical studies evaluating preoperative patient risk factors and preoperative diagnostic and treatment interventions were selected for review.
The literature search yielded 152 abstracts relevant to the PICO (patient/population, intervention, comparison, and outcomes) questions included in this chapter. The task force selected 65 articles for full-text review, and 24 were selected for inclusion in this systematic review. Twenty-three articles addressed preoperative patient risk factors. One article addressed preoperative diagnostic studies of pulmonary function. There were no studies meeting the inclusion criteria for preoperative pulmonary treatment.
There is substantial evidence for multiple preoperative patient factors that predict an increased risk of a postoperative pulmonary adverse event. Individuals with these risk factors (functional dependence, advanced age [≥65 yr], chronic obstructive pulmonary disease, congestive heart failure, weight loss, and obstructive sleep apnea) who are undergoing spine surgery should be counseled regarding the potential increased risk of a perioperative and postoperative pulmonary adverse events. There is insufficient evidence to support any specific preoperative diagnostic test for predicting the risk of postoperative pulmonary adverse events or any treatment intervention that reduces risk. It is suggested, however, to consider appropriate preoperative pulmonary diagnostic testing and treatment to address active pulmonary symptoms of existing or suspected disease.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/5-preoperative-pulmonary-evaluation-optimization.
目前尚无针对择期脊柱手术患者围手术期肺部评估和管理的推荐意见。
本指南旨在确定围手术期和术后肺部不良事件的术前危险因素，并确定高危患者的最佳术前评估和管理。
使用美国国立医学图书馆 PubMed 数据库和 Cochrane 图书馆对与脊柱手术患者术后肺部不良事件相关的研究进行系统文献回顾。选择评估术前患者危险因素和术前诊断及治疗干预的临床研究进行综述。
文献检索共获得 152 篇与本章 PICO（患者/人群、干预、比较和结果）问题相关的摘要。工作组选择了 65 篇全文进行审查，其中 24 篇被选入本系统综述。23 篇文章涉及术前患者危险因素。有 1 篇文章涉及术前肺功能诊断研究。没有符合术前肺治疗纳入标准的研究。
有大量证据表明多种术前患者因素可预测术后肺部不良事件的风险增加。有这些危险因素（功能依赖、年龄≥65 岁、慢性阻塞性肺疾病、充血性心力衰竭、体重减轻和阻塞性睡眠呼吸暂停）的接受脊柱手术的个体，应告知其围手术期和术后肺部不良事件的潜在风险增加。没有足够的证据支持任何特定的术前诊断测试来预测术后肺部不良事件的风险，也没有任何降低风险的治疗干预措施。然而，建议考虑适当的术前肺部诊断测试和治疗，以解决现有或疑似疾病的活动性肺部症状。完整的指南可在 https://www.cns.org/guidelines/browse-guidelines-detail/5-preoperative-pulmonary-evaluation-optimization 上获取。
