摘要
目的:分析全身麻醉经口气管插管下颈椎后路手术患者发生Tapia综合征风险及相关危险因素。方法:对2019年1月—2021年12月收治的行全身麻醉经口气管插管下颈椎后路手术治疗后发生Tapia综合征的7例患者临床资料进行回顾性分析,以年龄、性别、主刀医生及相同手术类型作为匹配条件,按1∶4原则,随机数字表法选择28例术后未发生Tapia综合征的患者作为对照组,对比两组麻醉时间、中立位下颌骨—椎体距离、中立位舌骨—椎体距离、中立位甲状软骨—椎体距离、过屈位舌骨—椎体距离、过曲位Cobb角、中立位Cobb角、住院时间等相关资料,分析Tapia综合征风险及相关危险因素。结果:术后Tapia综合征发生率为0.28%,症状出现在术后1~2d,平均症状出现时间(0.62±0.12)d。临床表现以伸舌偏移者6例(85.71%),构音障碍5例(71.43%),吞咽困难3例(42.86%),舌头表现不灵活者4例(57.14%),声音嘶哑者2例(28.57%)为主,经糖皮质激素、营养神经、康复锻炼等综合治疗,术后3个月复查患者症状改善。Tapia综合征患者中立位下颌骨—椎体距离明显低于对照组(P<0.05);且下颌骨—椎体距离由中立位至过屈位时,Tapia综合征组由3.96mm降至1.97mm,降幅为50.25%,而对照组由7.21mm降至4.92mm,降幅为31.76%。Tapia综合征患者术后住院时间、总住院时间均高于对照组(P<0.05)。结论:全身麻醉经口气管插管下颈椎后路手术患者发生Tapia综合征风险相对较低,但发生后可对患者术后康复及日常生活情况造成影响;术前中立位颈椎X片下颌骨角—椎体前缘距离较小可能是术后发生Tapia综合征的危险因素。
Objective:To analyze the risk of Tapia syndrome and related risk factors in patients undergoing posterior cervical spine surgery under general anesthesia through orotracheal intubation.Methods:From January 2019 to December 2021,the clinical data of 7 patients who developed Tapia syndrome after undergoing general anesthesia orotracheal intubation and posterior cervical spine surgery were retrospectively analyzed.The main surgeon and the same type of surgery were used as matching conditions.According to the principle of 1∶4,28 patients without Tapia syndrome after operation were selected as the control group by random number table method,neutral hyoid vertebral body distance,neutral thyroid cartilage vertebral body distance,hyperflexed hyoid vertebral body distance,hyperflexed Cobb angle,neutral Cobb angle,hospitalization time and other related data to analyze Tapia syndrome risk and associated risk factors.Results:The incidence of Tapia syndrome after operation was 0.28%.The majority of patients symptoms appeared 1~2 days after operation,with an average of(0.62±0.12)days.The clinical manifestations were 6 cases(85.71%)with tongue extension,5 cases(71.43%)with dysarthria,3 cases(42.86%)with dysphagia,4 cases(57.14%)with inflexible tongue,and 2 cases(28.57%)with hoarseness,treated with glucocorticoids,nutritional nerves,rehabilitation exercises and other comprehensive treatments,and the symptoms of the patients were improved 3 months after the operation.The neutral mandibular vertebral distance of the patients with Tapia syndrome was significantly lower than that of the control group group(P<0.05);and when the mandibular vertebral body distance was changed from neutral position to hyperflexion position,the Tapia syndrome group decreased from 3.96mm to 1.97mm,a decrease of 50.25%,while the control group decreased from 7.21mm to 4.92mm,a decrease of 31.76%.The postoperative hospital stay and total hospital stay in patients with Tapia syndrome were longer than those in the control group(P<0.05).Conclusion:The risk o
作者
张斌
ZHANG Bin(Zhumadian Guangji Hospital,Zhumadian City,He’nan Province 463000)
出处
《医学理论与实践》
2023年第3期384-386,389,共4页
The Journal of Medical Theory and Practice
