儿童阻塞性睡眠呼吸暂停低通气综合征围手术期处理

Perioperative management of obstructive sleep apnea hypopnea syndrome in children

目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)围手术期处理方法。方法 210例睡眠打鼾患儿,经多道睡眠图监测、新型睡眠检测仪HypnoPTT监测为OSAHS。术前检查扁桃体肥大和(或)腺样体肥大,全部采用气管插管静脉复合麻醉,行扁桃体腺样体切除术。最低血氧饱和度低于85%者,术前采用呼吸机治疗或低流量吸氧治疗3～5 d。结果所有患儿手术成功安全出院。手术时间平均(30±10)min,平均出血量(20±10)ml,平均住院天数(6.5±1.5)d,术后平均拔管时间(20±10)min。麻醉插管躁动(喉痉挛)4例,支气管痉挛5例,术中气管插管脱落3例,术后出血7例。结论根据儿童时期解剖生理特点,全麻手术风险较大,合理的围手术期处理可以减少并发症及避免其风险的发生。

OBJECTIVE To investigate the perioperative management of obstructive sleep apnea hypopnea syndrome in children.METHODS A total of 210 snoring children were diagnosed as obstructive s1eep apnea hypopnea syndrome（OSAHS）by polysomnography（PSG）or pulse transmit time examination（PTT）from August 2007 to August 2010.Preoperative examination confirmed tonsil and/or adenoid hypertrophy.All cases had tonsillectomy and/or adenoidectomy under endotracheal intubation and complex intravenous general anesthesia.Continuous positive airway pressure or low-flow oxygen inhalation was used for 3 to 5 days when the lowest oxygen saturation was less than 0.85.RESULTS All cases were well tolerated the procedure and discharged from hospital successfully.The mean operation time and detubation time were（30±10）minutes and（20±10）minutes respectively.The average amount of bleeding were（20±10）ml and mean in hospital period were（6.5±1.5） days.Four cases suffered laryngospasm and 5 cases had tracheospasm during intubation period.Intubation extraction occurred during operation in 3 cases and postoperative bleeding occurred in 7 cases.CONCLUSION According to the anatomic and physiological features of children,proper perioperative management can reduce the risk and complications of the operation.