颈动脉内膜切除术后气道梗阻的急诊管理：一项系统综述

文献信息

中文摘要

背景： 颈动脉内膜切除术后气道梗阻对麻醉医师构成重大挑战。气道水肿，伴或不伴血肿，可能迅速进展并导致危及生命的后果。本系统综述旨在为颈动脉内膜切除术后气道梗阻的管理提供最佳实践依据。方法：检索2000年1月1日至2025年7月1日期间发表的文献。纳入描述成年患者颈动脉内膜切除术后发生气道梗阻的麻醉管理文章。同时审查所纳入文章的参考文献列表以寻找其他相关来源。结局指标包括气道梗阻的表现、气道干预的成功率、气管插管持续时间以及气道相关并发症发生率和死亡率。使用纽卡斯尔-渥太华量表评估偏倚风险。结果：文献检索共获得284篇文章，其中32篇全文被审查。6篇论文被认为相关，另有5篇通过参考文献审查确定，最终共11篇纳入本系统综述（5篇病例报告、3篇病例系列和3篇回顾性观察性研究），详细描述了84例颈动脉内膜切除术后气道受损的管理。临床体征与解剖变形相关性差，喉水肿通常比预期更严重。及时清除血肿提高了气道管理的成功率，且无相关并发症或死亡。局部麻醉下手术探查有效，可能避免气道干预的需要。清醒气管插管比麻醉下气管插管并发症更少，在时间和患者配合允许的情况下应考虑使用。紧急颈前入路不应因反复尝试气管插管且失败可能性高而延迟。手术探查后患者气管应保持插管足够时间，使气道水肿在拔管前消退。结论：

英文摘要

Postoperative airway obstruction after carotid endarterectomy presents a significant challenge to anaesthetists. Airway oedema, with or without haematoma, may rapidly develop with life-threatening consequences. This systematic review aims to inform best practice in the management of postoperative airway obstruction following carotid endarterectomy. A literature search was conducted for manuscripts published between 01/01/2000 and 01/07/2025. Articles describing the anaesthetic management of adult patients who developed postoperative airway obstruction following carotid endarterectomy were included. Reference lists of the reviewed articles were also scrutinised for additional relevant sources. Outcome measures were the presentation of airway obstruction, success rate of airway interventions, duration of tracheal intubation and incidence of airway-related morbidity and mortality. Risk of bias was assessed using the Newcastle-Ottawa Scale. The literature search yielded 284 articles, of which 32 full papers were reviewed. Six papers were deemed pertinent, in addition to five identified from review of references, for a total of 11 included in this systematic review (five case reports, three case series and three retrospective observational studies) detailing the management of airway compromise post-carotid endarterectomy in 84 cases. Clinical signs correlate poorly with anatomical distortion, and laryngeal oedema is generally more severe than anticipated. Prompt haematoma evacuation improved the success rate of airway management, without associated morbidity or mortality. Surgical exploration under local anaesthesia was efficacious and may avoid the need for airway intervention. Awake tracheal intubation was associated with fewer complications than asleep tracheal intubation and should be considered where time and patient cooperation allow. Emergency front-of-neck access should not be delayed for repeated attempts at tracheal intubation with a high chance of failure. Patients' tracheas should remain intubated for sufficient time after surgical exploration, allowing airway oedema to resolve prior to extubation.