南方医科大学学报

南方医科大学学报 ›› 2006, Vol. 26 ›› Issue (05): 661-663.

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重度阻塞性睡眠呼吸暂停低通气综合征围手术期的处理

李润汉； 曾勇； 王跃建； 赵远新； 陈伟雄； 杨芳；   

  1. 佛山市第一人民医院耳鼻咽喉科； 佛山市第一人民医院呼吸内科 广东佛山528000； 广东佛山528000；
  • 出版日期:2006-05-20 发布日期:2006-05-20

Perioperative management of severe obstructive sleep apnea hypopnea syndrome

LI Run-han1,ZENG Yong1,WANG Yue-jian1,ZHAO Yuan-xin1,CHEN Wei-xiong1,YANG Fang2 Departments of Otorhinolaryngology1 and Respiration2,First People’s Hospital of Foshan,Foshan 528000,China   

  1. 佛山市第一人民医院耳鼻咽喉科； 佛山市第一人民医院呼吸内科 广东佛山528000； 广东佛山528000；
  • Online:2006-05-20 Published:2006-05-20

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摘要： 目的探讨重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)围手术期治疗的必要性。方法对53例重度有腭咽和舌根平面阻塞的OSAHS患者行保留悬雍垂腭咽成形术加舌根射频消融术。患者进行手术前后围手术期处理,如术前予以智能型持续正压通气机治疗,雾化吸入,术后心电监护,并行手术前后睡眠监测。结果53例OSAHS患者均顺利完成保留悬雍垂腭咽成形术加舌根射频消融术。术前睡眠呼吸暂停低通气指数(AHI)(58.4±5.1)次/h,最低血氧饱和度(LSaO2)0.650±0.059,术后AHI为(15.5±3.2)次/h,LSaO2为0.864±0.064。术后AHI、LSaO2均明显下降(P<0.01)。术后拔管窒息2例,术中出血较多1例,原发性出血2例,术后高血压危象1例,并发症发生率为11.3%(6/53)。结论重度OSAHS患者手术有极大的潜在危险,术前应用持续正压通气治疗及加强其他围手术期的处理能显著提高患者对手术及麻醉的耐受性,降低手术风险,减少并发症的发生。

Abstract: Objective To investigate the perioperative management of severe obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Fifty-three patients with severe OSAHS received uvulopalatopharyngoplasty with uvula preservation and radiofrequency tongue base reduction.All the patients were treated with automated continuous positive airway pressure(CPAP)for 3-7 days before operation and atomated antibiotic therapy administered in the oropharynx,with 24 h ECG monitoring postoperatively.Polysomnography were carried out before and 6 months after surgery.Results The preoperative apnea hyponea index(AHI)and lowest SaO2(LSaO2)were 58.4±5.1/h and 0.650±0.059,respectively,which were 15.5±3.2/h and 0.864±0.064 at 6 months after surgery,respectively,showing significant changes after surgery(P<0.01).Dyspnea occurred in 2 cases after operation,intraoperative bleeding in 1 case,primary bleeding in 2 cases and hypertension crisis in 1 case.Conclusion Severe OSAHS patients are subject to great surgical risk.Application of auto-CPAP before operation can significantly improve the patients’ tolerance of surgery and anesthesia,and reduce the surgical risks and preoperative complications. 

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