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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 cochlear implants in patients and provide clinical experience to avoid perioperative risks. Methods: A total of 1396 patients with severe or very severe sensorineural hearing loss were included, including 1 379 cases of prelingual deafness and 17 cases of adult deafness. ① preoperative routine examination: audiology, imaging, pediatric limbs, mental development assessment. ② Perioperative complications discussed: surgical complications, postoperative systemic complications and other problems. Results: ① The complications of surgery included 4 cases of postoperative transient facial paralysis, 14 cases of posterior wall of tympanic membrane and tympanic membrane perforation, 91 cases of “blowout” in operation, 2 cases of dura mild injury, 31 cases of electrode implantation (Distal electrode into the ear canal in 2 cases, 1 case to the vestibule; electrode distorted in the cochlea in 28 cases), postoperative transient vertigo of 231 cases, 39 cases of scalp hematoma. ② postoperative systemic complications: fever> 38 ℃ 21 cases, 27 cases of acute gastritis, bronchitis or pneumonia in 5 cases, laryngotracheitis in 9 cases. ③ other problems: 1 case of intraoperative implant replacement, computer malfunction mistaken for implant problems and carried out an unnecessary replacement. Conclusion: ①Cochlear implantation is a relatively less risk and safer operation, but there are still some perioperative risks that can not be ignored. The main manifestations are as follows: prevention of meningitis after cochlear malformation and “blowout”, intraoperative protection Facial nerve and drum nerve, correct opening of the cochlea and other issues. ② strictly in accordance with standard operating procedures, complete preoperative, intraoperative and postoperative links, personalized treatment for different patients to ensure the success of the operation.