中国神经再生研究(英文版) ›› 2017, Vol. 12 ›› Issue (3): 499-504.doi: 10.4103/1673-5374.202916

• 综述:脊髓损伤修复保护与再生 • 上一篇    

有利于急性颈髓损伤修复的麻醉计划及麻醉医生应关注的重点

  

  • 收稿日期:2016-12-25 出版日期:2017-03-15 发布日期:2017-03-15

Anesthetic considerations for patients with acute cervical spinal cord injury

Fang-ping Bao, Hong-gang Zhang, Sheng-mei Zhu   

  1. Department of Anesthesiology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
  • Received:2016-12-25 Online:2017-03-15 Published:2017-03-15
  • Contact: Hong-gang Zhang, M.D., zhg1979@ hotmail.com.

摘要:

麻醉医生对急性颈髓损伤最关注的是如何避免或减少对神经系统的二次损伤和改善预后。为达到此目的,就必需了解和熟悉急性颈髓损伤的病理特点,才能并结合自有的技能及设备优势制定处优化的麻醉管理方案。麻醉医生术前访视时应仔细体格检查,注意定位损伤部位和损伤程度,并关注神经保护措施;注意气道管理对颈髓移位和挤压的影响,建议非紧急情况下纤支镜清醒插管或紧急情况下手工中立位固定下喉镜插管;诱导时避免使用易导致低血压的药物和去极化肌松药;术中维持平均压85-90 mmHg(1 mmHg=0.133 kPa),合理选择血管活性药物和配液,纠正心动过缓,维持正常二氧化碳压力和血糖;合理利用好术中神经监护;对患者术后监护室管理中应特别注意术后呼吸功能不全,慎重考虑术后拔管条件,避免血栓形成和感染发生。文章重点突出介绍麻醉医生对急性颈髓损伤患者的关注重点,帮助麻醉医生制定麻醉计划达到神经保护并改善预后的目的。

ORCID:0000-0002-0161-3736(Hong-gang Zhang)

关键词: 神经再生, 脊髓损伤, 颈髓损伤, 麻醉, 呼吸道管理, 诱导, 插管, 脑保护, 神经电生理, 神经保护

Abstract:

Anesthesiologists work to prevent or minimize secondary injury of the nervous system and improve the outcome of medical procedures. To this end, anesthesiologists must have a thorough understanding of pathophysiology and optimize their skills and equipment to make an anesthesia plan. Anesthesiologists should conduct careful physical examinations of patients and consider neuroprotection at preoperative interviews, consider cervical spinal cord movement and compression during airway management, and suggest awake fiberoptic bronchoscope intubation for stable patients and direct laryngoscopy with manual in-line immobilization in emergency situations. During induction, anesthesiologists should avoid hypotension and depolarizing muscle relaxants. Mean artery pressure should be maintained within 85–90 mmHg (1 mmHg = 0.133 kPa; vasoactive drug selection and fluid management). Normal arterial carbon dioxide pressure and normal blood glucose levels should be maintained. Intraoperative neurophysiological monitoring is a useful option. Anesthesiologists should be attentive to postoperative respiratory insufficiency (carefully considering postoperative extubation), thrombus, and infection. In conclusion, anesthesiologists should carefully plan the treatment of patients with acute cervical spinal cord injuries to protect the nervous system and improve patient outcome.

Key words: nerve regeneration, cervical spine injury, cervical spinal cord injury, spinal cord injury, anesthesia, airway management, induction, intubation, neuroprotection, neurophysiological monitorin, neuroprotection, neural regeneration