在前头骨底部手术后早期使用CPAP:手术后的脑脊液泄漏病例报告的警告故事
Marcin Marciniak1, Vidit M Talati2, Sean A Setzen3
1Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, 60612, USA; Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA.
American journal of otolaryngology
|October 21, 2025
概括
在骨底部手术后过快恢复持续正气道压力 (CPAP) 治疗可能会导致脑脊液泄漏等并发症. 谨慎的时间和监测对于阻塞性睡眠呼吸暂停 (OSA) 患者至关重要.
科学领域:
- 神经外科 神经外科
- 耳鼻喉科 耳鼻喉科 耳鼻喉科
- 睡眠医学 睡眠医学
背景情况:
- 持续正气道压力 (CPAP) 是阻塞性睡眠呼吸暂停 (OSA) 的标准,但由于风险,在骨底部手术后通常是禁忌的.
- 停止CPAP可以使患者的生活质量恶化,并导致心肺问题.
- 在扩展的头骨底部手术后恢复CPAP的指导方针缺乏,大多数研究都集中在跨形手术上.
研究的目的:
- 为了突出早期CPAP恢复在内镜骨底部手术后的潜在风险.
- 强调需要个性化术后护理策略的OSA患者进行骨底部手术的需要.
主要方法:
- 病例报告:一名51岁的男性患有OSA,接受了内镜前骨基逆转乳头瘤切除.
- 尽管接受了咨询,但患者在术后的第21天重新启动了CPAP,导致脑脊液 (CSF) 泄漏和肺脑.
- 手术修复涉及解决持续撕裂和重新定位鼻腔;CPAP在手术后的第57天恢复,没有问题.
主要成果:
- 早期使用CPAP后的头骨底部手术导致CSF泄漏和肺.
- 手术干预成功地修复了长期撕裂和膜脱落.
- 延迟恢复CPAP的耐受性很好,这表明适当时间的重要性.
结论:
- 在扩展的头骨底部手术后早期恢复CPAP具有重大风险,包括CSF泄漏.
- 需要标准化的指导方针来管理复杂的头骨底部方法后的术后期CPAP治疗.
- 进一步研究CPAP压力传输到前脑是优化患者的结果至关重要的.
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