目的:使用半固定位置(SSP)优化后颅窝手术(PFS)的手术定位,以避免静脉空气栓塞(VAE)及其可能危及生命的后果,作者通过分析大量PFS患者,评估了他们在SSP中的经验.
方法:对202名连续PFS患者(中位年龄54岁,IQR41-61岁;121名女性)患有各种肿瘤或血管疾病,在2019年至2022年之间接受了SSP手术。年龄,性别,体重,高度,BMI,美国麻醉医师协会(ASA)班,组织学,手术持续时间,并评估住院时间。术前和术中使用经食管超声心动图监测和评估VAE的程度。
结果:总之,202例患者中有30例(14.9%)发生VAE,与临床相关的VAE发生在202例患者中的14例(7%)。VAE的等级是我,III,和IV在16(8%),4(2%),和10名(5%)患者,分别。患者身高(p=0.04),ASA等级(p=0.03),ASA≤II级(p=0.02)仍然是术中VAE的唯一具有统计学意义的术前危险因素,临床相关VAE患者的中位身高为178cm(IQR172-184cm),而无VAE患者的中位身高为170cm(IQR164-176cm)。
结论:总之,数据表明,在术中特别注意优化高、低等ASA患者的定位时,SSP可安全用于PFS.
OBJECTIVE: To optimize surgical positioning for posterior fossa surgery (PFS) using the semisitting position (SSP) to avoid venous air embolism (VAE) and its possible life-threatening consequences, the authors evaluated their experiences with the SSP by analyzing a large cohort of PFS patients.
METHODS: A retrospective analysis of the charts of 202 consecutive PFS patients (median age 54 years, IQR 41-61 years; 121 females) with various tumor or vascular conditions who underwent surgery in an SSP between 2019 and 2022 was performed. Age, sex, weight, height, BMI, American Society of Anesthesiologists (ASA) class, histology, duration of surgery, and length of hospital stay were assessed. Transesophageal echocardiography was used pre- and intraoperatively to monitor for and assess the degree of VAE.
RESULTS: Altogether, VAE occurred in 30 of 202 (14.9%) patients, with clinically relevant VAE occurring in 14 of 202 (7%) patients. The grades of VAE were I, III, and IV in 16 (8%), 4 (2%), and 10 (5%) patients, respectively. Patient height (p = 0.04), ASA class (p = 0.03), and ASA class ≤ II (p = 0.02) remained the only preoperative statistically significant risk factors for intraoperative VAE, with a median height of 178 cm (IQR 172-184 cm) in patients with clinically relevant VAE compared with 170 cm (IQR 164-176 cm) in those without VAE.
CONCLUSIONS: In summary, the data demonstrate that SSP can be used safely for PFS when taking special care to optimize positioning in tall and lower-grade ASA patients intraoperatively.