颈椎前路手术后血肿的发生率、危险因素及气道管理：一项回顾性巢式病例对照研究
Incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery: a retrospective nested case-control study.
作者信息
Tian Yang, Li Jiao, Zhou Guangjin, Wang Mingya, Qu Yinyin, Li Min, Wang Jun, Xu Mao, Wang Shenglin, Guo Xiangyang, Han Yongzheng
机构信息
Department of Anesthesiology, Peking University Third Hospital, Beijing, China.
Department of Radiology, Peking University Third Hospital, Beijing, China.
出版信息
BMJ Open. 2025 Apr 7;15(4):e090547. doi: 10.1136/bmjopen-2024-090547.
OBJECTIVE
The aim of this study was to investigate the incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery (ACSS).
DESIGN
A retrospective nested case-control study.
SETTING
A tertiary hospital in China.
PARTICIPANTS
A total of 13 523 patients within a single-centre longitudinal ACSS cohort were identified from March 2013 to February 2022. Patients with postoperative haematoma after ACSS were enrolled as the haematoma group, and others in the cohort without haematoma were randomly selected as the non-haematoma group by individually matching with the same operator, same gender, same surgery year and similar age (±5 years) at a ratio of 4:1. Subsequently, patients with haematoma were included in a subgroup for analysis.
PRIMARY OUTCOME MEASURES
Postoperative haematoma and difficult intubation prior to haematoma evacuation.
RESULTS
The incidence of postoperative haematoma out of all ACSS was 0.4% (55/13 523). A total of 275 patients were enrolled in the study, including 55 patients in the haematoma group and 220 patients in the non-haematoma group. Anterior cervical corpectomy and fusion (ACCF) (OR 2.459; 95% CI 1.302 to 4.642; p =0.006) and the maximum mean arterial pressure (MAP) during recovery (OR 1.030; 95% CI 1.003 to 1.058; p =0.028) were identified as independent risk factors for haematoma. In the subgroup analysis, 29% of patients with haematoma experienced difficult intubation, and retropharyngeal haematoma (OR 10.435; 95% CI 1.249 to 87.144; p =0.030) was identified as an independent risk factor for difficult intubation. Patients with haematoma had longer hospitalisation duration (p <0.001) and greater costs associated with their stay (p <0.001).
CONCLUSION
ACCF and elevated maximum MAP during the recovery period were independent risk factors for postoperative haematoma following ACSS. Patients with post-ACSS haematoma are at high risk of a difficult airway, with retropharyngeal haematoma being strongly associated with challenging airway management. Postoperative haematoma was associated with longer hospitalisation duration and greater costs.
TRIAL REGISTRATION NUMBER
China Clinical Trial Registry: ChiCTR2400086263.
目的
本研究旨在调查颈椎前路手术（ACSS）后血肿的发生率、危险因素及气道管理情况。
设计
一项回顾性巢式病例对照研究。
地点
中国一家三级医院。
参与者
2013年3月至2022年2月期间，从单中心纵向ACSS队列中识别出13523例患者。ACSS术后发生血肿的患者被纳入血肿组，队列中其他无血肿的患者按4:1的比例与同一手术医生、相同性别、相同手术年份且年龄相近（±5岁）进行个体匹配，随机选取作为非血肿组。随后，将血肿患者纳入亚组进行分析。
主要观察指标
术后血肿及血肿清除术前的困难插管情况。
结果
所有ACSS患者中术后血肿的发生率为0.4%（55/13523）。本研究共纳入275例患者，其中血肿组55例，非血肿组220例。颈椎前路椎体次全切除融合术（ACCF）（比值比[OR]2.459；95%置信区间[CI]1.302至4.642；p = 0.006）和恢复期间的最高平均动脉压（MAP）（OR 1.030；95% CI 1.003至1.058；p = 0.028）被确定为血肿的独立危险因素。在亚组分析中，29%的血肿患者出现困难插管，咽后血肿（OR 10.435；95% CI 1.249至87.144；p = 0.030）被确定为困难插管的独立危险因素。血肿患者的住院时间更长（p < 0.001），住院费用更高（p < 0.001）。
结论
ACCF和恢复期最高MAP升高是ACSS术后血肿的独立危险因素。ACSS术后血肿患者气道困难风险高，咽后血肿与具有挑战性的气道管理密切相关。术后血肿与更长的住院时间和更高的费用相关。
试验注册号
中国临床试验注册中心：ChiCTR2400086263
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