UPPP术后并发症发生率及危险因素分析

Prevalence and prognostic factors for postoperative complications of uvulopalatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome

目的:探讨UPPP术后24h内并发症的发生率及其危险因素,为早期预防术后并发症的发生提供理论依据。方法:回顾性分析162例接受UPPP手术的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者,按照有无发生术后并发症进行分组,比较2组患者术前及术中各项临床指标的差异,对重要的临床参数作单因素及多元逐步Logistic回归分析。结果:31例(19.1%)患者术后24h内出现并发症,包括呼吸并发症21例(13.0%),心血管并发症6例(3.7%),术后出血9例(5.6%)。并发症组和无并发症组之间在BMI、AHI、LSAT及困难插管等方面均差异有统计学意义(均P<0.05)。多因素回归分析显示,BMI(OR=1.136)、AHI(OR=4.828)及困难插管(OR=1.971)为术后24h内出现并发症的独立危险因素。结论:OSAHS患者术前BMI、AHI及麻醉困难插管是预测术后24小时内出现并发症的主要指标。对于肥胖、严重OSAHS患者及插管困难患者,应提高警惕,做好围术期处理,避免术后并发症的发生。

Objective： To explore the complication incidence and risk factors within immediate 24 hours after uvulopalatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and provide theoretical foundation for preventing postoperative complication incidence. Method： 162 patients undergoing UPPP procedure between Mar, 2002, and Oct 2006, were analysed retrospectively. All patients were divided into two groups according to the development of postoperative complications or not. The retrospective chart review focused on the demographic data and pertinent history, preoperative sleep evaluation, surgical and anesthetic management, and need for postoperative interventions. Potential risk factors were first evaluated with univariate analysis fol lowed by multivariate logistic regression with the occurrence of complications within immediate 24 hours after op- eration as the dependent variable. Result： A total of 162 consecutive cases for UPPP were enrolled into current study. 31 cases （19.1%） had postoperative complications necessitating a medical intervention, including respiratory complications （ n = 21, 13.0 % ）, cardiovascular complications （ n = 6,3.7 % ） and hemorrhage （ n = 9,5.6 % ）. The differences in body mass index （BMI）, apnea-hypopnea index （AHI）, lowest oxygen saturation （LSAT） and difficult intubation were significant between two groups. Risk factors for postoperative complications were BMI （ OR =1,136, 95%CI： 1. 007-2. 558, P =0. 049）, preoperative AHI （ OR =4. 828, 95%CI： 1. 827-13. 924, P =0. 012） and difficult intubation （ OR =1. 971,95%CI： 1. 251 4,839, P =0. 034）. Conclusion：. Baseline BMI and AHI, difficult intubation in anaesthetic procedure were the most important predictors of postsurgical morbidity. Keeping in mind the aforementioned cautionary notes, aggressively preoperative preparation should be applied for such populations to avoid the occurrence of postoperative complications.