1396例人工耳蜗植入围手术期并发症讨论  

Perioperative complications of 1396 patients with cochlear implantation

作　　者：李玉洁[1] 张道行[1] 

机构地区：[1]首都医科大学附属北京友谊医院耳鼻咽喉科,北京100050

出　　处：《临床耳鼻咽喉头颈外科杂志》2010年第10期433-435,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:通过对人工耳蜗植入患者围手术期并发症的讨论,为回避围手术期风险提供临床经验。方法:1396例双耳重度或极重度感音神经性聋患者,其中语前聋1 379例、成人语后聋17例。①术前常规检查:听力学、影像学、小儿肢体、智力发育评估。②围手术期并发症讨论:手术并发症、术后全身并发症及其他问题。结果:①手术并发症:术后一过性面瘫4例,外耳道后壁及鼓膜损伤穿孔14例,术中"井喷"91例,硬脑膜轻度损伤2例,电极植入问题31例(远端电极进入内耳道2例,到前庭1例;电极在蜗内扭曲打折28例),术后一过性眩晕231例,头皮血肿39例。②术后全身并发症:发热>38℃21例,急性胃炎27例,支气管炎或肺炎5例,喉气管炎9例。③其他问题:术中1例植入体更换,电脑故障误认为是植入体问题而进行了不必要的更换。结论:①人工耳蜗植入术是相对风险较少、较为安全的手术,但仍存在不可忽视的围手术期风险,主要表现在:预防畸形耳蜗"井喷"后的脑膜炎,术中保护面神经与鼓索神经,正确开放耳蜗鼓阶等问题。②严格按标准操作规程,完成术前、术中、术后每一个环节,针对不同患者行个性化处理,以保证手术的成功。Objective：To discuss the perioperative complications of 1396 cases（1402 ears） with cochlear implantation（CI）,and to supply clinical experience for risk reduction in the perioperative period.Method：All patients were profound sensorineural deafness,with 1379 prelingual cases and 17 postlingual cases.①Preoperative examinations： audiology,imaging studies,evaluation of physical and intellectual development.②Perioperative complications.Result：①perioperative complications：transitory postoperative facial palsy in 4 cases;external auditory canal and membrana tympani injury in 14 cases;gusher in 91 cases;cerebral dura mater injury in 2 cases;problems of electrodes in 31 cases including 2 of electrodes inserted into inner auditory canal and 1 into scala vestibuli,28 of electrodes squirm in the cochlea;transient vertigo in 231 cases;scalp hematoma in 39 cases.②systematic postoperative complications：fever（〉38℃）in 21 cases;acute gastritis in 27 cases;bronchitis and pneumonia in 5 cases;laryngotracheitis in 9 cases.③other complications：artificial cochlear exchange due to computer trouble during operation.Conclusion：①CI is a relatively safe surgical procedure,but risks still persist during perioperative period including postoperative meningitis,facial nerve and chorda tympani nerve injury,and so on.②To ensure successful operation,perioperative managements should be standardized.

关 键 词：人工耳蜗植入术 并发症 围手术期 

分 类 号：R318.18[医药卫生—生物医学工程]