患者身高与美国麻醉医师协会（ASA）分类为后颅窝手术的显著风险因素（半坐位）

Patient height and American Society of Anesthesiologists class as significant risk factors for posterior fossa surgery in the semisitting position

JOURNAL OF NEUROSURGERY

影响因子:3.6

分区:医学2区 / 临床神经病学2区外科2区

发表日期:2025 Feb 01

作者: Farjad Khalaveh, Mehmet-Salih Yildirim, Martin Niederle, Johannes Herta, Christian Matula, Christian Dorfer, Karl Rössler

DOI: 10.3171/2024.4.JNS24205

摘要

为了优化半坐位（SSP）用于后颅窝手术（PFS）的手术体位，避免静脉空气栓塞（VAE）及其可能的危及生命的后果，作者分析了大量PFS患者的经验。对2019年至2022年期间在该位置接受手术的202例连续患者（中位年龄54岁，IQR 41-61岁；女性121名）进行了回顾性分析，患者具有不同的肿瘤或血管疾病。评估指标包括年龄、性别、体重、身高、BMI、美国麻醉医师协会（ASA）分类、组织学类型、手术时间和住院天数。术前及术中使用经食道超声心动图监测VAE的发生及程度。总体而言，VAE发生在202例患者中，占比14.9%，其中临床相关VAE发生在14例（7%）。VAE的等级包括I、III和IV，分别占16（8%）、4（2%）和10（5%）例。患者身高（p=0.04）、ASA分类（p=0.03）以及ASA ≤ II级（p=0.02）成为唯一具有统计学意义的术前风险因素。具有临床相关VAE的患者中，中位身高为178厘米（IQR 172-184厘米），而无VAE患者的中位身高为170厘米（IQR 164-176厘米）。总结而言，数据表明在特别注意优化高个子和低ASA级别患者的体位情况下，半坐位可安全用于后颅窝手术。

Abstract

To optimize surgical positioning for posterior fossa surgery (PFS) using the semisitting position (SSP) to avoid venous air embolism (VAE) and its possible life-threatening consequences, the authors evaluated their experiences with the SSP by analyzing a large cohort of PFS patients.A retrospective analysis of the charts of 202 consecutive PFS patients (median age 54 years, IQR 41-61 years; 121 females) with various tumor or vascular conditions who underwent surgery in an SSP between 2019 and 2022 was performed. Age, sex, weight, height, BMI, American Society of Anesthesiologists (ASA) class, histology, duration of surgery, and length of hospital stay were assessed. Transesophageal echocardiography was used pre- and intraoperatively to monitor for and assess the degree of VAE.Altogether, VAE occurred in 30 of 202 (14.9%) patients, with clinically relevant VAE occurring in 14 of 202 (7%) patients. The grades of VAE were I, III, and IV in 16 (8%), 4 (2%), and 10 (5%) patients, respectively. Patient height (p = 0.04), ASA class (p = 0.03), and ASA class ≤ II (p = 0.02) remained the only preoperative statistically significant risk factors for intraoperative VAE, with a median height of 178 cm (IQR 172-184 cm) in patients with clinically relevant VAE compared with 170 cm (IQR 164-176 cm) in those without VAE.In summary, the data demonstrate that SSP can be used safely for PFS when taking special care to optimize positioning in tall and lower-grade ASA patients intraoperatively.