重症阻塞性睡眠呼吸暂停低通气综合征患者死亡原因分析

An analysis of the cause and countermeasure of death of patients with severe obstructive sleep apnea hypopnea syndrome

目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）检查治疗时发生患者死亡的原因及防治对策.方法 对6家医院在检查治疗中死亡的6例OSAHS患者的病例资料进行回顾性分析.结果 6例患者中肥胖4例次 合并高血压2次,心脏病2例次,肺功能异常或影像有改变2例次,糖尿病1例次 2例无合并症病史.患者中3例未行多道睡眠图（PSG）监测,1例在PSG监测时发生意外死亡,2例呼吸暂停低通气指数（AHI）分别为56次/h和82次/h.死亡原因分别为：手术开始前诱导麻醉后行气管插管困难,致呼吸道梗阻死亡2例 悬雍垂腭咽成形术（UPPP）后出血,待行全麻止血手术,使用肌松剂后气管插管困难,因缺氧时间过长造成脑水肿,长期昏迷死亡1例 1例术前肺功能检查发现气道阻力过高,全麻UPPP术后患者清醒状态下拔除气管插管时心跳呼吸骤停死亡 1例术前查体发现心肺等器官存在潜在性病变,全麻气管插管后气管切开行UPPP术后,患者清醒状态下更换气管套管时心跳停止,抢救无效死亡 1例患有高血压、冠心病、糖尿病、肥胖病,心电图示心功能三级,呈呼吸性酸中毒状态患者,行PSG监测时反复呼吸暂停,最后诱发心跳骤停,抢救无效死亡.结论 应高度警惕OSAHS患者致死性严重并发症的可能.强调OSAHS患者外科治疗的适应证选择.对重症患者应在改善其心肺功能及全身情况后再手术.严格细致地做好围术期每一环节的预案和准备工作,防止严重并发症的发生.

Objective To discuss the causes and countermeasures of death of severe obstructive sleep apnea hypopnea syndrome （OSAHS） patients undergoing tests or treatment. Methods A retrospective study of the data of six patients with severe OSAHS who died undergoing tests or treatment in 6 hospitals was conducted. Results Among the 6 patients, overly fat were found in 2 cases, hypertension in 2 cases, cardiac diseases in 2 cases, abnormal pulmonary function or chest X-ray in 2 cases, diabetes in 2 cases, while 2 cases had no above positive finding. Three patients did not have polysomnography （PSC）. One patient died during PSG test. Two patients＇ apnea hypopnea index （AHI） were 56 times/h and 82 times/h respectively. The causes of death were as follows, two patients died of airway obstruction and unsuccessful tracheal intubation before uvulopalatopharyngoplasty （UPPP） operation. One died of encephaledema in long-term coma due to airway obstruction, long time poor oxygenation and unsuccessful tracheal intubation with muscle relaxants before hemostasis procedure for treating postoperative hemorrhage. One patient whose preoperative pulmonary function showed increased airway resistence died of cardiac and respiratory arrest after tracheal extubation when UPPP surgery finished. One who was found to have potential cardiac and pulmonary disorder died of cardiac arrest when doctors were replacing his tracheal intubation with a cannula, before the tube replacing procedure the patient was conscious. One who had hypertension, coronary heart disease, diabetes mellitus and adiposis suffering from respiratory acidosis with his electrocardiogram showing a level-three heart function died of cardiac arrest with repeated apnea during PSG monitoring. Conclusions OSAHS patients with severe complications should be treated extremely carefully. The indication of surgery should be strictly observed. OSAHS patients can not undergo surgery until their cardiopulmonary functions and general conditions are improved.