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急性脊髓硬膜外血肿清除术的气道管理：病例报告及文献回顾

贵州医科大学麻醉与心脏电生理课题组

翻译：王婷婷编辑：王婷婷审校：曹莹

背景：术后脊髓硬膜外血肿（pSEH）是显微椎间盘切除术的一种罕见并发症。术中血肿可能未被注意到，但及时治疗可防止永久性神经功能损害。饱胃患者的气道管理通常通过快速顺序插管和全身麻醉进行。清醒脊柱手术无需静脉镇痛或镇静，对于因非麻醉性经口给药（NPO）状态丧失而导致全麻下肺吸入风险较高的饱胃患者可能有益。作者提出，它也可以在紧急/紧急术后硬膜外血肿清除的情况下进行。

研究方法：我们报告了一位41岁的男性患者的气道管理，他接受了微创椎间盘切除术，术后即刻肌力正常，但由于硬膜外血肿，在术后2小时内出现了进行性无力伴右脚背屈、右拇长伸肌无力和进行性右下肢上升性麻木。

结果：病人接受紧急清醒硬膜外血肿清除与脊髓麻醉。之后，患者恢复神经功能，并于次日早晨出院。

临床相关性：pSEH是显微椎间盘切除术的罕见并发症。本文旨在描述清醒脊柱手术在紧急硬膜外血肿清除中的新用途，并证明其可行性。

结论：在紧急情况下，当患者不是NPO时，可以安全地在没有镇静剂的情况下进行清醒脊柱手术，确保患者可以保护他们的气道并避免吸入风险。

原始文献来源：Ononogbu-Uche FC, Gold C, Brena KR, et al. Airway Management for Emergency Spinal Epidural Hematoma Evacuation With Awake Spine Surgery: Case Report and Literature Review. Int J Spine Surg. 2024;18(1):69-72. Published 2024 Mar 4. doi:10.14444/8569

Airway Management for Emergency Spinal Epidural Hematoma Evacuation With Awake Spine Surgery: Case Report and Literature Review

Background: Postoperative spinal epidural hematomas (pSEHs) are a rare complication of microdiscectomy surgery. The hematoma may be unnoticed intraoperatively, but timely treatment may prevent permanent neurologic impairment. Airway management in patients with a full stomach is generally performed with rapid sequence intubation and general anesthesia. Awake spine surgery without intravenous analgesia or sedation may be beneficial in patients with a full stomach who are at higher risk for pulmonary aspiration with general anesthesia due to a loss of non-per-oral (NPO) status. The authors propose that it can also be performed in cases of urgent/emergent postsurgical epidural hematoma evacuation.

Methods: We present the airway management of a 41-year-old man who underwent a minimally invasive microdiscectomy with normal strength immediately after surgery but developed progressive weakness with right foot dorsiflexion, right extensor hallucis longus muscle weakness, and progressive right lower extremity ascending numbness over the course of the first 2 hours after surgery due to an epidural hematoma.

Results: The patient underwent urgent awake epidural hematoma evacuation with a spinal anesthetic. Afterward, the patient recovered neurological function and was discharged the following morning.

Clinical relevance: pSEHs are a rare complication of microdiscectomy surgery. The purpose of this article is to describe the novel use of awake spine surgery in emergent epidural hematoma evacuation and demonstrate its feasibility.

Conclusions: In emergencies, when a patient is not NPO, awake spine surgery can safely be performed with no sedation, ensuring the patient can protect their airway and avoid the risk of aspiration.

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