聂颖,唐靖,张建,林涛
NIE Ying,TANG Jing,ZHANG Jian,LIN Tao

• 1:南方医科大学附属南方医院麻醉科
• 2:广东三九脑科医院神经外科

摘要(Abstract)：

目的:探讨脑干肿瘤手术围麻醉期主要不良事件的相关影响因素。方法:收集107例脑干肿瘤手术治疗患者的性别、年龄、术前麻醉医师协会(ASA)分级、病变部位及性质、术前是否合并脑积水或肺炎、手术及麻醉时间、麻醉方式等资料,观察围麻醉期患者心率失常、血压波动、延迟拔管、咳嗽多痰以及术中神经电生理监测(IONM)失败等不良事件发生情况,采用Logistic回归分析对不良事件发生的相关因素进行分析。结果:术前ASA分级、病变性质以及术前合并脑积水是出现循环系统不良事件的危险因素,95%CI分别为1.801~12.350、1.496~7.300及1.009~3.583;术前ASA分级、病变部位以及术前合并肺炎是出现呼吸系统不良事件的危险因素,95%CI分别为1.123~21.825、19.384~370.350及3.036~43.094;全凭静脉麻醉(TIVA)是出现IONM失败的保护因素,95%CI为2.939~21.776。结论:术前ASA分级、病变部位和性质、以及术前是否合并脑积水或肺炎是出现围麻醉期主要不良事件的危险因素,TIVA是出现IONM失败的保护因素。
Objective: To explore the risk factors involved in anesthesia adverse events during surgery of brainstem tumor by Logistic regression. Methods: The clinical data involved in 107 surgical cases of brainstem tumors surgery were collected,including gender,age,preoperative American Society of Anesthesiologists( ASA),the site and category of lesion,hydrocephalus,pneumonia,duration of operation and anesthesia,anesthetic method. The main anesthesia adverse events such as arrhythmia,hemodynamic changes,delayed extubation,cough and phlegmy,failure in intraoperative neurophysiological monitoring( IONM) were observed in perioperative period. These anesthesia adverse events related risk factors were analyzed by Logistic regression analysis. Results: Preoperative ASA,the category of lesion and preoperative complicated hydrocephalus were risk factors for adverse events of circulatory system,and 95% confidence interval( CI) were 1. 801 ~ 12. 350,1. 496 ~ 7. 300,1. 009 ~ 3. 583,respectively. Preoperative ASA,the site of lesion and preoperative complicated pneumonia were risk factors for adverse events in respiratory system,and 95% CI were 1. 123 ~ 21. 825,19. 384 ~370. 350,3. 036 ~ 43. 094,respectively. Total intravenous anesthesia( TIVA) was a protective factor for INOM failure,and 95% CI was 2. 939 ~ 21. 776. Conclusion: Risk factors for anesthesia adverse events are preoperative ASA,the site and category of lesion,and preoperative complicated hydrocephalus or pneumonia. TIVA is a protective factor for IONM failure.

关键词(KeyWords)： 脑干肿瘤;外科手术;麻醉;危险因素;Logistic回归分析
brainstem neoplasm;surgery;anesthesia;risk factors;Logistic regression analysis

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 聂颖,唐靖,张建,林涛
NIE Ying,TANG Jing,ZHANG Jian,LIN Tao

DOI: 10.19367/j.cnki.1000-2707.2016.05.030

参考文献(References)：

• [1]毛颖,蔡加君,姚瑜.脑干胶质瘤的现状及展望[J].中华神经外科疾病研究杂志,2015(2):97-100.
• [2]李防晔,陈晓雷,许百男.脑干海绵状血管瘤的手术治疗进展[J].中国神经精神疾病杂志,2013(4):254-256.
• [3]Schaller B,Probst R,Strebel S,et al.Trigeminocardiac reflex during surgery in the cerebellopontine angle[J].J Neurosurg,1999(2):215-220.
• [4]Koerbel A,Gharabaghi A,Samii A,et al.Trigeminocardiac reflex during skull base surgery:mechanism and management[J].Acta Neurochir,2005(7):727-733.
• [5]Gharabaghi A,Acioly de Sousa MA,Tatagiba M.Detection and prevention of the trigeminocardiac reflex during cerebellopontine angle surgery[J].Acta Neurochir,2006(11):1223.
• [6]曹合利,田恒力,胡锦,等.神经外科麻醉对体感诱发电位的影响[J].中国微侵袭神经外科杂志,2007(10):445-447.
• [7]刘海洋,韩如泉.麻醉药物对神经外科术中诱发电位的影响[J].医学综述,2010(11):1730-1733.
• [8]Sinha S,Kale SS,Chandra SP,et al.Brainstem gliomas:Surgical indications and technical considerations in a series of58 cases[J].Br J Neurosurg,2014(2):220-225.
• [9]Sun T,Wan WQ,Wu Z,et al.Clinical outcomes and natural history of pediatric brainstem tumors:with 33 cases follow-ups[J].Neurosurg Rev,2013(36):311-320.
• [10]唐自跃,蒋华,何思伟.小儿脑干肿瘤切除术1例的麻醉处理[J].四川医学,2007(7):811.
• [11]Webb MD,Unkel JH.Anesthetic management of the trigeminocardiac reflex during mesiodens removal-A case report[J].Anesth Prog,2007(54):7-8.
• [12]Stavrinou P,Foroglou N,Patsalas I,et al.Trigeminocardiac reflex and ipsilateral mydriasis during stereotactic brain tumor biopsy:an insight into the anatomical and physiological pathways involved[J].Acta Neurochir,2010(152):727-728.
• [13]Toma S,Christo T,Lili L,et al.Central trigeminocardiac reflex in pediatric neurosurgery:a case report and review of the literature[J].Journal of Medical Case Reports,2012(6):372.
• [14]郭永正,翁院峰.脑干肿瘤显微手术25例麻醉处理体会[J].福建医科大学学报,1997(4):447-448.
• [15]张淑珍,周晓丽,王恩真,等.脑干手术全静脉麻醉中保留自主呼吸应激反应的变化[J].中华麻醉学杂志,1999(3):140-142.
• [16]陈建华,王冬青.138例脑干及临近区域手术中的麻醉方法分析[J].齐齐哈尔医学院院报,2002(11):1254.
• [17]聂颖,李韧韧.经口与经鼻气管插管对围脑干肿瘤术后带管患者的影响[J].医学信息,2013(5):255-256.
• [18]任天剑.颅神经运动核的定位及持续肌电图监测在脑干手术中的应用[J].中华神经外科杂志,2005(1):60-62.
• [19]邵锦根,乔慧,刘淑玲.脑干听觉和体感诱发电位在脑干肿瘤手术监护中的联合应用[J].浙江医学,2006(1):72-73.
• [20]聂颖,张建,阳湘安,等.全凭静脉麻醉对脑干肿瘤手术中神经电生理监测的影响[J].广东医学,2014(14):2256-2259.

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