Peng Lin, Li Qiang, Zheng Lingxi, Zhao Deng, Fu Qiang
Department of Anesthesiology, The Third People's Hospital of Chengdu (The Affiliated Hospital of Southwest Jiaotong University), College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China.
Department of Anesthesiology, The Third People's Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China.
Front Med (Lausanne). 2025 Apr 16;12:1503912. doi: 10.3389/fmed.2025.1503912. eCollection 2025.
Ankylosing spondylitis (AS) is a progressive inflammatory disease causing severe kyphosis, which complicates surgical management and increases complication risks. This study aims to analyze the characteristics of severe kyphosis in AS and explore methods to optimize perioperative management and reduce complications.
We conducted a retrospective analysis of clinical data from five patients with severe kyphosis in AS who underwent surgery between October 2017 and February 2022. The patients had a mean age of 40.20 ± 8.50 years. The analysis included pathophysiological changes in folded patients and perioperative multidisciplinary intervention guidance. It also covered strict preoperative anesthetic evaluations, establishing an optimal fluid pathway during surgery, precise anesthetic monitoring and management, and applying postoperative multimodal analgesia and rehabilitation exercises to optimize perioperative anesthetic management.
Preoperative cardiopulmonary function exercises were required to ensure patients could withstand surgery and anesthesia. Awake fiberoptic tracheal intubation was used to ensure airway safety and anesthesia. Hemodynamic evaluation and management were conducted using PICCO monitoring. Somatosensory evoked potentials (SSEP) and myogenic motor evoked potentials (MMEP) were utilized for neural axis monitoring. Hypothermia was designed to protect the spinal cord. To prevent massive blood loss, controlled hypotension and autotransfusion were implemented.
The correction operation of severe spinal kyphosis is complex and requires a detailed anesthesia plan. Optimizing the management of difficult airways and respiratory regulation, guiding circulation and fluid management through comprehensive monitoring, avoiding factors that aggravate complications, improving postoperative analgesia, and encouraging active rehabilitation exercises are crucial goals for perioperative anesthesia management.
强直性脊柱炎（AS）是一种进行性炎症性疾病，可导致严重驼背，这使手术管理复杂化并增加并发症风险。本研究旨在分析AS中严重驼背的特征，并探索优化围手术期管理和减少并发症的方法。
我们对2017年10月至2022年2月期间接受手术的5例AS严重驼背患者的临床资料进行了回顾性分析。患者的平均年龄为40.20±8.50岁。分析包括驼背患者的病理生理变化和围手术期多学科干预指导。它还涵盖严格的术前麻醉评估、在手术期间建立最佳液体通路、精确的麻醉监测和管理，以及应用术后多模式镇痛和康复锻炼以优化围手术期麻醉管理。
术前需要进行心肺功能锻炼，以确保患者能够耐受手术和麻醉。采用清醒纤维支气管镜气管插管以确保气道安全和麻醉。使用脉波指示剂连续心排血量监测（PICCO）进行血流动力学评估和管理。体感诱发电位（SSEP）和肌源性运动诱发电位（MMEP）用于神经轴监测。采用低温以保护脊髓。为防止大量失血，实施控制性低血压和自体输血。
严重脊柱驼背的矫正手术复杂，需要详细的麻醉计划。优化困难气道管理和呼吸调节、通过综合监测指导循环和液体管理、避免加重并发症的因素、改善术后镇痛以及鼓励积极的康复锻炼是围手术期麻醉管理的关键目标。
