阻塞性睡眠呼吸暂停低通气综合征患者的术前评估

Preoperative assessment of patients with obstructive sleep apnea hypopnea syndrome

目的对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者术前做出较全面准确评估,以降低围术期危险。方法对82例OSAHS患者术前各脏器功能状况进行评估。结果全身体格健康情况ASA(American society anesthesiologists)分级II级56例,III级23例,IV级3例;合并心血管、肝、肾与内分泌等脏器功能损害者:1项18例,2项40例,3项及以上14例,其余10例无。病史5年以上者均合并单个或多个脏器受损。OSASH分级轻度17例,中度46例,重度19例;肥胖45例,超重20例,二者中94%合并脏器受损;颈围(46.76±4.47)cm,其中68例>40cm;舌咽分级III～IV级68例;颏甲距离<6.5cm69例,评估插管困难者72例。因严重合并症暂缓手术者10例,放弃2例。结论OSAHS患者术前并存诸多危险因素,术前应作出准确评估。

Objective To make an appropriate preoperative assessment of patients with obstructive sleep apnea hypopnea syndrome（OSAHS） for reducing the perioperative risk. Methods Perioperative organ conditions were assessed in 82 OSAHS patients. Results According to the American Society of Anesthesiologists （ ASA ） grading, 56 patients were in ASA Ⅱ grade, 23 patients in ASA Ⅲ , 3 patients in ASA Ⅳ. As for the eombination of organ dysfunetion, ineluding cardiovascular, hepatic, renal and endocrine system, was concerned, 18 cases had one item, 40 cases had 2 items, 14 eases had 3 or more items, 10 eases had no item. On OSAHS grading： mild 17 eases, moderate 46 eases, severe 19 eases. Of all the patients, 45 were assessed as obesity and 20 as overweight, 94% of which coexisted with organ injury. The mean neck eollar was （46.76 ±4.47） em with 68 eases 〉40 cm. Tongue-pharynx elassifieation： elass Ⅲ- Ⅳ 68 cases. Seventy-two eases were assessed as having intubation diffieuhies. As a result, operations were suspended in 10 cases, abandened in 2 eases because of the severe eomplieations. Conclnsions There are lots of eoneomitant preoperative risk factors in patients with OSAHS. Correct assessment should be made before operation. （Chin J Ophthalmol and Otorhinolaryngol,2008 ,8 ：30-32 ）