睡眠呼吸暂停综合征术前经鼻正压通气的治疗

Preoperative nasal continuous positive airway pressure treatment as substitute for protective tracheostomy in severe obstructive sleep apnea syndrome

目的试用经鼻正压通气（ｎａｓａｌｃｏｎｔｉｎｕｏｕｓｐｏｓｉｔｉｖｅａｉｒｗａｙｐｒｅｓｕｒｅ，ＮＣＰＡＰ）替代对重度阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ，ＯＳＡＳ）患者行悬雍垂腭咽成形术（ｕｖｕｌｏｐａｌａｔｏｐｈａｒｙｎｇｏｐｌａｓｔｙ，ＵＰＰＰ）前的预防性气管切开术，避免术中、术后出现致死性并发症。方法患者均为行ＵＰＰＰ治疗的重度ＯＳＡＳ，以１９９１年１１月～１９９４年４月患者５２例为对照组；１９９４年５月～１９９６年的患者４２例为治疗组。对照组及治疗组均经全夜７小时多导睡眠仪监测（ｐｏｌｙｓｏｍｎｏｇｒａｐｈｙ，ＰＳＧ）确诊，两组治疗前主要参数对比差异无显著性。对照组中７例，于ＵＰＰＰ术前行预防性气管切开；另一例术中呼吸骤停，紧急气管切开。而治疗组中类似严重患者９例，均于ＵＰＰＰ术前接受ＮＣＰＡＰ治疗。ＮＣＰＡＰ治疗仪的正压水平平均为１．１６ｋＰａ（１１．８５ｃｍＨ２Ｏ），治疗时间平均９天，将治疗组ＮＣＰＡＰ治疗前后ＰＳＧ各项重要指标进行观察比较。结果经ＮＣＰＡＰ治疗后，治疗组最长呼吸暂停时间由８４．４６±７７．４２秒降至１５．４２±２４．３６秒，?

Objective Preoperative nasal continuous positive airway pressure(NCPAP) treatment was used as a substitute for protective tracheostomy before UPPP surgery in 42 patients with severe obstructive sleep apnea syndrome(OSAS)from 1994 to 1996. Methods Fifty two patients operated on three years before this period served as control group. All cases were diagnosed as severe OSAS by polysomnography (PSG). Results There were no statistical difference in main parameters between two groups. Seven cases in the control group underwent protective tracheostomy whose apnea and hypopnea index(AHI) was 28.4～83.5 and lowest saturation oxygen (SaO 2)were 7%～32%. One patient underwent emergency tracheostomy due to life threatening situation during uvulopalatopharyngoplasty (UPPP). There were 9 similarly severe cases who did not undergo protective tracheostomy in NCPAP treatment group. All patients underwent preoperative 5～20 day NCPAP treatment in treatment group. The average positive pressure was 1.16 kPa(11.85 cmH 2O). There were significant difference in main parameters between the two groups. The AHI, SaO 2 and sleep structure were evidently improved. UPPP was safely performed without protective tracheostomy and any complications in all patients with NCPAP treatment. Conclusion This result implys that NCPAP treatment could be used as a substitute for protective tracheostomy before UPPP in severe OSAS.