由于Dural撕裂和脑脊髓液泄漏而导致的后期气道损害
Larry R Hutson1, Russell K McAllister1
1Department of Anesthesiology, Baylor Scott & White Medical Center-Temple, Temple, TX.
Ochsner journal
|December 25, 2023
概括
前脊椎手术的一种罕见的延迟并发症,由持续性撕裂引起的脑脊液 (CSF) 泄漏,可能导致气道损害. 这一案例凸显了在以后的演讲中考虑CSF收集的重要性.
科学领域:
- 神经外科 神经外科
- 耳鼻喉科 耳鼻喉科 耳鼻喉科
背景情况:
- 宫性脊柱障碍是前性脊柱手术后的一个常见并发症.
- 宫持续性撕裂是罕见的并发症,而来自脑脊液 (CSF) 收集的呼吸道损害更为罕见.
- 脑脊液采集的延迟呈现是不寻常的,大多数病例发生在手术后的几天内.
研究的目的:
- 报告一个罕见的延迟呼吸道损害的病例,原因是前椎切除和融合后的宫持续撕裂.
- 强调在患者出现后期出现的液体积聚和呼吸系统损害时考虑持续性的重要性.
主要方法:
- 一个55岁的男性患者的病例报告显示,他在前椎手术后3周出现了渐进的消化不良和呼吸损害.
- 诊断成像显示了广泛的后喉和侧部液体收集,导致呼吸道狭窄.
- 进行了醒着的光纤输管,并确定液体是来自宫持续撕裂的脑脊液,随后修复.
主要成果:
- 该患者在手术后3周出现了严重的呼吸道损害,原因是手术后3周内大量的CSF收集.
- 手术修复了宫硬膜撕裂,并安置了腰部排水管,使她完全康复.
- 患者在手术后的第二天被抽管,并在11天后出院.
结论:
- 宫持续性撕裂是前宫脊椎手术的罕见并发症,通常在术后早期出现.
- 临床医生应考虑在晚些时候出现液体收集和呼吸道症状的患者中进行持续的眼和随后的CSF采集.
- 识别CSF的液体可以告知麻醉管理,包括潜在的需要腰部排水,以减少压力在dural修复.
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