急危重症合并阻塞性睡眠呼吸暂停低通气综合征的诊治探讨

Clinical Study on Critically Ⅲ Patients Suffering from Obstructive Sleep Apnea-Hypopnea Syndrome

目的探讨急危重症合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床特点和治疗方法。方法对安阳地区医院2003年1月至2007年12月收住重症加强治疗病房(ICU)的急危重症合并OSAHS患者的病历资料进行回顾分析。结果 79例患者的OSAHS均是在抢救现场经观察、询问病史、体格检查、Epworth嗜睡量表调查及判断嗜睡评分给予初步诊断,病情稳定后多导睡眠图监测均确诊为OSAHS。在治疗原发急危重症基础上,及时给予持续气道正压(CPAP)或双水平气道正压通气(BiPAP)治疗。2例死亡,77例痊愈出院。患者在ICU住院2～23 d(平均5.91 d)。结论及时诊治OSAHS是抢救急危重症的关键之一。急危重症患者初步诊断为OSAHS后,在治疗原发病的同时,给予CPAP或BiPAP呼吸支持治疗,可取得较好临床疗效。

Objective To explore the diagnosis and treatment of critically ill patients suffering from obstructive sleep apnea-hypopnea syndrome（OSAHS）.Methods Critically ill patients with OSAHS admitted in intensive care unit from January 2003 to December 2007 were retrospectively analyzed.Results Seventy-nine critically ill patients were diagnosed as OSAHS.The initial diagnosis of OSAHS was made by history requiring,physical examination,and Epworth sleepiness score evaluation.The final diagnosis was comfirmed by polysomnography thereafter.Base on the treatment of primary critical diseases,the patients were given respiratory support either with continuous positive airway pressure（CPAP） or with bi-level positive airway pressure ventilation（BiPAP）.Two cases died and the remaining 77 patients were cured and discharged.Conclusions Timely diagnosis of OSAHS is important to rescue the critically ill patients.Respiratory support combined with treatment of primary critical diseases can improve the outcomes of these patients.