郭晓睿　李蕾　张蓉　郭丹　谢彧之　付强　周寒梅

Evidence summary of anesthesia management in adolescent with idiopathic scoliosis during perioperative period

GUO Xiaorui，LI Lei，ZHANG Rong，GUO Dan，XIE Yuzhi，FU Qiang，ZHOU Hanmei The Third People′s Hospital of Chengdu，Sichuan 610031 ChinaCorresponding Author ZHOU Hanmei，E－mail：2413143272@qq.com

Abstract Objective：To summarize the best evidence of perioperative anesthesia management in adolescent patients with idiopathic scoliosis，and to provide reference for clinical practice.Methods：According to the "6S" evidence resource pyramid model，the evidence of perioperative anesthesia management in adolescent patients with idiopathic scoliosis was searched layer by layer from top to bottom in computer decision system，guideline website，professional association website，evidence－based database and comprehensive database.The search deadline was from database establishment to August 1，2023.Two researchers trained in systematic evidence－based methodology independently conducted literature quality evaluation，evidence extraction integration，and summary grading.Results：A total of 8 articles were included，including 5 expert consensus articles and 3 Meta－analysis articles.The 39 best evidences were summarized from five aspects：preoperative anesthesia evaluation，preoperative anesthesia guidance，intraoperative anesthesia management，gastrointestinal adverse reactions management and postoperative pain management.Conclusion：This study systematically summarized the best evidence of perioperative anesthesia management in adolescent patients with idiopathic scoliosis，and provided evidence－based reference for the practice of anesthesiologists.In clinical work，the availability of resources and the suitability of measures should be considered，and the best evidence should be selected for transformation and application，so as to promote the continuous improvement of medical quality of anesthesia.

Keywords adolescent idiopathic scoliosis;perioperative period;anesthesia management;evidence summary;evidence－based nursing

摘要 目的：总结现有青少年特发性脊柱侧凸病人围术期麻醉管理的最佳证据，为临床医护实践提供参考依据。方法：根据“6S”证据资源金字塔模型，自上而下逐层检索计算机决策系统、指南网站、专业协会网站、循证数据库以及综合数据库中有关青少年特发性脊柱侧凸病人围术期麻醉管理的证据内容。检索时限为建库至2023年8月1日。由2名经过系统化循证方法学培训的研究者独立进行文献质量评价、证据提取整合和汇总分级。结果：共纳入8篇文献，包括专家共识5篇和Meta分析3篇。从术前麻醉评估、术前麻醉指导、术中麻醉管理、胃肠不良反应管理和术后疼痛管理5个方面进行了总结，形成了39条最佳證据。结论：本研究系统总结了现有青少年特发性脊柱侧凸病人围术期麻醉管理的最佳证据，为麻醉医护人员的实践提供了循证参考依据。临床工作中需考虑资源的可及性与措施的适宜性，选择最佳证据进行转化应用，从而促进麻醉医疗质量持续改进。

关键词 青少年特发性脊柱侧凸；围术期；麻醉管理；证据总结；循证护理

doi：10.12102/j.issn.2095－8668.2024.02.003

青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）是10～18岁人群最为常见的脊柱畸形疾病。其发病率地域差异明显，全球发病率为0.47%～5.20%［1］。在我国，AIS约占所有脊柱侧凸分型的90%［2］。目前，对于站立位冠状面Cobb角测量大于40°，经保守治疗无效且进行性加重者主要采用后路矫形融合（posterior spinal fusion，PSF）手术的方式进行治疗。由于手术难度高，持续时间长，创伤打击大，且多数病人心肺功能不佳，故实施麻醉的风险很高。……