背景:颈椎前路手术(ACSS)后气道阻塞可能是致命的并发症。偶尔,它迅速发展到完全阻塞。关于医务人员应如何评估体征和症状,尚无既定的标准化协议,寻求帮助,或促进ACSS后的气道管理,以防止不良事件。本研究旨在通过评估ACSS患者气道受损的体征和治疗结果,主要描述一种系统方法。Further,建议医护人员根据患者的症状在拔管后采取行动方案,以防止不良结局。
方法:在PubMed上进行了广泛的文献检索,WebofScience,和Cochrane图书馆来识别病例报告,案例系列,和队列研究仅限于英语,发表于1990年1月至2023年3月之间。我们包括描述这些迹象的案例,症状,ACSS术后气道阻塞的治疗。同时,涉及其他已知原因的并发症的病例,外伤或枕颈固定术的病例,或排除使用骨形态发生蛋白的患者。
结果:从17项研究中获得了20例,他们的研究质量是可以接受的。四名病人死亡,2例出现缺氧缺血性脑病。Further,6例患者中有5例出现了致命的并发症,最初是在手术后7小时内出现的。然后,有血肿证据的13例患者中有9例(69%)在手术后12小时内出现初始症状。最后,11例早期症状患者中有9例获得了良好的预后,出现晚期症状的患者通常有不利的结局.
结论:早期识别体征和症状并立即治疗很重要,特别是在术后12小时内。我们根据症状的紧迫性为医务人员提出了一种新的行动方案,其中包括使用用于评估颈部肿胀的字符串测量颈部周长。
BACKGROUND: Postoperative airway obstruction after anterior cervical spine surgery (ACSS) can be a fatal complication. Occasionally, it rapidly progresses to complete obstruction. There are no established standardized protocols on how medical staff should assess for signs and
symptoms, seek help, or facilitate airway management after ACSS to prevent unfavorable events. This study aimed to primarily describe a systematic approach by assessing the signs and treatment outcomes of airway compromise in patients who underwent ACSS. Further, it recommended an action protocol after extubation for medical staff according to patients\' symptoms to prevent unfavorable outcomes.
METHODS: An extensive literature search was performed on PubMed, Web of Science, and the Cochrane Library to identify
case reports,
case series, and cohort studies restricted to English and published between January 1990 and March 2023. We included cases that described the signs,
symptoms, and treatment of airway obstruction after ACSS. Meanwhile, cases involving complications of other known causes, cases of trauma or occipital-cervical fixation, or those using bone morphogenetic protein were excluded.
RESULTS: Twenty cases from 17 studies were obtained, and their study quality was acceptable. Four patients died, and two presented with hypoxic ischemic encephalopathy. Further, five of six patients had fatal complications that initially developed within 7 h after surgery. Then, 9 (69%) of 13 patients with evidence of hematoma (69%) showed initial symptoms within 12 h after surgery. Finally, 9 of 11 patients with early-stage symptoms had favorable outcomes, and patients who developed late-stage
symptoms commonly had unfavorable outcomes.
CONCLUSIONS: The early identification of signs and symptoms and immediate treatment are important, particularly within 12 h postoperatively. We suggest a novel action protocol for medical staff according to symptom urgency, which includes the measurement of neck circumference using a string for evaluating neck swelling.