重度阻塞性睡眠呼吸暂停低通气综合征围手术期处理对术中及术后出血的影响

Effect of peri-operative treatment on hemorrhage for patients with severe obstructive sleep apnea hypopnea syndrome

目的探讨对重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者在围手术期进行正压通气治疗(continue positive airway pressure,CPAP)及血压控制后,术中应用电刀对术中术后出血的影响。方法应用多导睡眠监测仪和Holter心电及血压检测仪对具有打鼾症状的患者进行监测,将合并高血压的252例OSAHS患者分为对照组、治疗组。对照组于围手术期常规口服降压药物治疗,不行CPAP治疗,术中不应用电刀;治疗组围手术期应用CPAP治疗,静滴降压药物,随时控制血压于稳定状态,术中应用电刀。对两组患者术中、术后的出血量进行比较分析。结果治疗组出血量明显少于对照组(P<0.01),差异有统计学意义。结论围手术期正压通气可以有效改善患者因长期缺氧而导致的机体损害,有利于血压保持正常稳定状态,提高手术耐受力,动态的血压控制和应用电刀可以有效减少术中出血量及术后出血的机会,降低手术危险性,避免严重并发症的发生。

Objective To investigate the effect of electrotome on hemorrhage following continue positive airway pressure（CPAP） and ambulatory blood pressure control in patients with severe obstructive sleep apnea hypopnea syndrome （OSAHS） . Methods 252 patients with OSAHS and hypertension were divided into the control group and the treatment group. The control group was orally subjected to drugs to control blood pressure without CPAP and electrome, while the treatment group was subjected to infusion drugs to control blood pressure and was also treated with CPAP and electrotome in the operations. Results The bleeding was significandy less in the treatment group than in the control group（ P 〈 0.01）. Conclusion Peri-opemtive management is important for decreasing the hemorrhage during and after operations in patients with severe OSAHS.