阻塞性睡眠呼吸暂停综合征围术期麻醉管理

Perioperative anaesthetic management of OSAS

目的 :降低OSAS围术期死亡率 ,探求合理麻醉和管理。方法 :OSAS患者 14 2例 ,采用丁卡因表麻 +镇静健忘经鼻腔气管插管全麻 ,给予适度镇静催眠药物使患者嗜睡 ,保留自主呼吸 ,能按指令主动配合气管插管。先行盲插 ,失败后喉镜明视 ,估计插管困难直接用纤支镜导引 ,病情重者行气管切开。术后拔管指征 :患者意识完全清醒 ,吸空气 >10min ,SpO2 >90 % ,吸净气管、口腔内分泌物拔管。结果 :14 1例经鼻气管插管 ,1例气管切开 ,96例盲插成功 ,32例明视 ,13例纤支镜导引。诱导期有轻微呼吸抑制 ,经指令深呼吸和面罩吸氧后 ,SpO2 迅速 >90 % ,无一例诱导期发生险情。 2 3例术后 30min内拔管 ,115例带管回病房于术后 ( 10± 6 )h拔管 ,3例术后气管切开。 3例术后出血 ,其中 2例未拔管 ,1例拔管后 4 0min并发生急性呼吸道梗阻 ,经抢救脱离危险。全组无一例死亡。结论 :镇静健忘慢诱导经鼻气管插管全麻 。

Objective:To explore reasonable anesthetic management and deminish perioperative mortality of OSAS. Methods:Awake nasotracheal intubation of cocaine topical anesthesia combined with intraveneous drug sedation was applied to 142 patients (except one case with tracheotomy) receiving general anesthesia for UPPP,during which the patients were asleep but had spontaneous ventilation so they could breathe profoundly according to orders and help to be intubed actively by blind,under the direct laryngoscopy and using fiberoptic laryngoscopy in different situation. Signs for extubation: Removed the tube after suction of the pharynx and endotrachea when the patients were entirely awake and SpO_2>90% with breathing air>10min. Results:141 cases nasotracheal intubation included 96 cases blind nasotracheal intubation and 32 cases under the direct laryngoscopy and 13 cases using fiberoptic laryngoscopy,some of which showed slightly respiratory depression during induction but SpO_2 was rapidly higher than 90% after mandatory breathing and oxygen inhalation by face mask. 23 cases were extubated after operation. 115 cases went back ward wearing tubes and were extubed after (10±6) h. 3 cases were tracheostomized at the end of the operation. 3 cases bled after operation,two with tubes and one without tube which suffered from acute respiatary obstrution. No case was dead. Conclusion:Awake nasotracheal intubation combined with timely extubation were effective maneuvers in preventing perioperative death of OSAS.