阻塞性睡眠呼吸暂停低通气综合征PACU处理的临床分析

Analysis of patients in the post-anesthesia care unit with obstructive sleep apnea and hypopnea syndrome

目的回顾分析阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea and hypopnea syndrome，OSAHS）患者麻醉恢复室（post-anesthesia care unit，PACU）处理的临床资料，提高围术期安全性，降低并发症。方法分析我院东区PACU收治的96例OSAHS患者，对镇静镇痛方式、呼吸机治疗、监测手段进行总结。结果患者年龄26-62岁，体重70-112kg，呼吸暂停，低通气指数（AHI）≥40，合并高血压37例、糖尿病12例，心电图检查示ST段或T波改变22例，左心室高电压17例，完全性右束支传导阻滞9例。所有患者术后均保留经鼻气管插管PACU过夜，1例患者拔管后再插管入ICU治疗，其余患者术后第2天晨拔管返回病房，均未发生术后知晓、气管切开、术后出血。结论重症OSAHS患者术后给予合理镇静镇痛留置气管导管过夜是安全和快速恢复的理想方式。

Objective To analyze retrospectively clinical data of patients with obstructive sleep apnea and hypopnea syndrome （OSAHS） in post-anesthesia care unit （PACU） in order to increase the patients＇ perioperative safety and minimize complications. Methods 96 cases of OSAHS in PACU of Beijing Tongren Hospital from January 2008 to December 2008 were analyzed retrospectively.Mode of sedation-analgesia,treatment of respirator and monitoring measure were summarized. Results Patients aged from 26 to 62 with apnea-hypopnea index （AHI）≥40 were recruited. The body weights were recorded from 70 to 112 kg. There were 37 cases complicated with hypertension and 12 with diabetes mellitus.The ECG of 22 cases revealed ST segment abnormality or ST-T changes. In addition, there were 17 cases whose ECG showed left ventricular high voltage and 9 cases with complete right bundle branch block.All of them underwent uvulopalatopharyngoplasty （UPPP） surgery with tracheal tube remained for 12-24 h, they were extubated on the second day after operation except one who was reintubated and transferred to ICU.No awareness was observed during sedation and no tracheotomy or postoperative hemorrhage occurred. Conclusions Tracheal tube should be remained in patients with severe OSAHS undergoing UPPP surgery till the next day.It is an ideal way to recovery from the suitable mode of sedation-analgesia.