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[哈灵顿脊柱侧弯手术:围手术期的麻醉问题]

[The Harrington scoliosis operation: the anesthesiological problems in the perioperative phase].

作者信息

Koch H J

机构信息

Klinikum Lindenhof, Mannheim, Germany.

出版信息

Rom J Intern Med. 1996 Jan-Jun;34(1-2):127-36.

PMID:8963252
Abstract

85 histories of scoliosis patients who had the operation with Harrington rod instrumentation were analysed retrospectively in order to reveal perioperative anaesthesiological problems. The cardiovascular and pulmonary alterations represented in addition to the length and the area involved eo ipso was a risk during narcosis. The neurolept analgesia in combination with inhalation anaesthetics after introduction with a barbiturate proved to be a safe procedure. The tachycardia turned out to be the main cardiovascular postoperative complication, which also characterised the situation after one week. In contrast, the blood pressure remained relatively stable. The average blood loss of 1.75 l was responsible for a postoperative anaemia, whilst serious depletions of hemoglobin below 8 mg% could be corrected immediately. Temperatures above 40 degrees C were not noticed. There was no indication for renal damage. The electrolytes did not show serious imbalances in comparison with the extreme fluid fluctuations. The blood gas analysis spoke for a bias to partially compensated respiratory alkalosis during the operation and acidosis postoperatively. The vital capacity was improved significantly by preoperative training. Depressed values of the vital capacity were still measured one week after spondylodesis. In conclusion, the results showed that moderate tachycardia was the most frequent complication of the Harrington operation. The Harrington procedure was a safe therapeutical option.

摘要

为揭示围手术期麻醉问题,对85例接受哈林顿棒器械手术的脊柱侧凸患者的病史进行了回顾性分析。心血管和肺部改变除了涉及的长度和面积外,本身就是麻醉期间的一种风险。在使用巴比妥酸盐诱导后,神经安定镇痛与吸入麻醉剂联合使用被证明是一种安全的方法。心动过速是术后主要的心血管并发症,术后一周的情况也是如此。相比之下,血压保持相对稳定。平均失血量1.75升导致术后贫血,而血红蛋白严重低于8mg%可立即得到纠正。未发现体温高于40摄氏度的情况。没有肾脏损伤的迹象。与极端的液体波动相比,电解质没有显示出严重的失衡。血气分析表明,手术期间存在部分代偿性呼吸性碱中毒倾向,术后存在酸中毒。术前训练显著提高了肺活量。脊柱融合术后一周仍可测得肺活量降低值。总之,结果表明中度心动过速是哈林顿手术最常见的并发症。哈林顿手术是一种安全的治疗选择。

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