重度阻塞性睡眠呼吸暂停低通气综合征患者术后留置气管插管的疗效观察

Clinical research on postoperative tracheal intubations in patients with obstructive sleep apnea and hyponoea syndrome

目的：探讨重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea and hyponoea syndrome．OSAHS）患者术后留置气管插管的临床效果。方法：重度OSAHS患者26例，行悬雍垂腭咽成形术（UPPP）或改良悬雍垂腭咽成形术（韩氏-悬雍垂腭咽成形术，H—UPPP）手术，术后留置经鼻气管插管。带管期间，给予镇静、镇痛、呼吸道管理、心理教育等临床处理，并监测处理前、处理期间及拔除气管插管后的心率、呼吸频率、血压、动脉血氧饱和度。结果：术后、OSAHS留置气管插管1h后至拔除气管插管时心率、呼吸频率、血压均明显低于处理前（P〈0．05～P〈0．01），6h动脉血氧饱和度显著提高（P〈0．01）。患者对气管插管耐受性提高，无一例发生呼吸道梗阻等严重并发症。结论：通过积极的临床处理，重度OSAHS患者术后带气管插管安全、有效，能有效避免发生严重术后并发症。

Objective： To investigate the clinical application of postoperative tracheal intubations in patients with obstructive sleep apnea and hyponoea syndrome（ OSAHS）. Methods：All 26 patients with severe OSAHS underwent uvulopalatopharyngoplasty（ UPPP）, Nasotracheal intubation was performed and patients received clinical treatment postoperatively such as sedation, analgesia, respiratory care and psychological education. The heart rate,respiratory rate, blood pressure and sarteria oxygen saturation （SAO2 ） were monitored before,during the treatment and after tracheal exubation. Results：Between 1 hour after intubations and tracheal extubation, the heart rate,respiratory rate and blood pressure were decreased significantly（ P 〈 0. 05 to P 〈 0.01 ）, SAO2 was increased greatly at 6 hours after treatment（ P 〈 0.01 ）, The tolerance of tracheal intubated patients was increased. No severe postoperative complications happened, Conclusions：With active clinical treatments,postoperative tracheal intubations are safe and effective in patients with OSAHS,which can avoid severe postoperative complications after UPPP.