侧颅底术后医院获得性肺炎患者临床特征与处理  

Clinical Features and Management of Hospital-Acquired Pneumonia following Lateral Skull Base Surgery

作　　者：田旭 冯国栋 杨华 吴海燕 魏兴梅 张竹花[2] 赵杨 周娅琳[3] 高志强 TIAN Xu;FENG Guodong;YANG Hua;WU Haiyan;WEI Xinmei;ZHANG Zhuhua;ZHAO Yang;ZHOU Yalin;GAO Zhiqiang(Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China;Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China;Operating Room, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医院耳鼻咽喉头颈外科,北京100730 [2]中国医学科学院北京协和医院放射科,北京100730 [3]中国医学科学院北京协和医院手术室,北京100730

出　　处：《中华耳科学杂志》2019年第3期317-323,共7页Chinese Journal of Otology

基　　金：“十二五”国家科技支撑计划重点项目(2012BAI2B01)~~

摘　　要：目的探讨侧颅底手术后医院获得性肺炎患者的临床特征、诊治措施及预防方法。方法回顾分析我院2016年12月至2018年12月诊治的5例侧颅底手术后医院获得性肺炎患者的临床特征、诊治等临床资料,探讨其防治措施。结果 5例侧颅底手术后医院获得性肺炎患者的主要临床特征:以胸闷、发热、咳脓痰为主要表现;5例患者年龄54-80岁,平均年龄64岁、合并基础疾病、手术复杂、手术时间长、术后均转ICU监护、呼吸机辅助机械通气治疗、并且有不同程度吞咽功能障碍。5例患者均经过积极有效抗感染、对症支持治疗后康复出院。结论侧颅底手术因病情复杂,手术操作精细、时间长、创伤大,常常会涉及颈内动静脉、脑膜脑组织、后组颅神经等容易危及生命的功能结构,导致术后患者发生医院获得性肺炎机会增大,应针对相关危险因素及时采取有效预防、诊治控制措施,以减少术后获得性肺炎的发生。Objective To report clinical characteristics, diagnosis and treatment measures and prevention of hospital-acquired pneumonia in patients undergoing lateral skull base surgeries. Methods We reviewed and analyzed clinical characteristics, diagnosis and treatment of 5 cases of hospital-acquired pneumonia following lateral skull base surgeries from December 2016 to December 2018. Results Main clinical features in the 5 patients with hospital-acquired pneumonia after lateral skull base surgery included chest tightness, fever and purulent expectoration, as well as various degrees of dysphagia. The 5 patients were aged between 54 and 80 years(average = 64 years) with concomitant baseline diseases, complex surgeries and long operation time, and were all transferred to ICU with assisted mechanical ventilation for postoperative management. They all recovered and were discharged from hospital after aggressive antibiotic and support treatments. Conclusion In addition to complicated conditions, delicate operation, long operation time and significant surgical trauma, lateral skull base surgery often involves major blood vessels in the vicinity, the meninge and/or brain, lower cranial nerves and other important structures that can be potentially life-threatening and associated with increased chance of postoperative hospital-acquired pneumonia. In order to reduce the incidence of hospital-acquired pneumonia,effective prevention, diagnosis, treatment and management measures should be taken in a timely manner according to relevant risk factors.

关 键 词：侧颅底 手术 医院获得性肺炎 诊断治疗 预防 

分 类 号：R764[医药卫生—耳鼻咽喉科]