阻塞性睡眠呼吸暂停低通气综合征围手术期监护体系

Establishment of an OSAHS peri-operative monitoring system

目的探讨建立围手术期监护体系在阻塞性睡眠呼吸低通气综合征(OSAHS)治疗中的意义。方法回顾性分析100例OSAHS患者围手术期发生各种严重并发症的情况,分为两组来对比研究,未进行系统的围手术期治疗者50例作为A组;建立围手术期监护者50例作为B组。建立围手术期监护体系主要包括从手术前的系列查体,到各个专业的会诊治疗,从局部的影像定位和PSG监测,到3～7 d的正压通气治疗,必要时的气管切开手术,从手术的麻醉护理的精深麻醉和配合,到手术后的ICU监护,而后到普通病房的特殊护理,到出院后的健康教育。结果 A组术中因并发症死亡1例,术后发生原发性咽部出血10例、继发性出血10例、气管阻塞2例、气管切开2例。B组患者术中、术后均未发生咽部出血、气管阻塞、气管切开的情况。B组较A组并发症的发生率明显降低(P<0.05),两组均无其他严重心脑血管并发症出现。结论 OSAHS患者手术有极大的潜在危险性,建立OSAHS围手术期监护体系,加强围手术期的治疗能显著提高患者对手术及麻醉的耐受性,降低手术风险,减少各种术中、术后并发症的发生。

Objective To explore the significance of a perioperative monitoring system in the treatment of obstructive sleep apnea-hypopnea syndrome（OSAHS）.Methods One hundred OSAHS patients were divided into group A and group B,in which the patients in group A did not receive the systematic perioperative treatment,while the patients in group B received the treatment.The perioperative monitoring system mainly included the following： physical examination before the surgery,doctors′ consultation from different departments,determination of the obstruction by imaging studies and PSG monitoring,3-5 days positive airway pressure treatment,tracheastomy if necessary,deep anesthesia/intensified anesthetic care,ICU monitoring after the surgery,special care at the ward,and post-discharge health education.The incidence of the complications was retrospectively analyzed.Results In group A,one patient died.Complictions consisted of ten postoperative primary pharyngeal hemorrhages,ten secondary hemorrhages,two tracheal obstructions,and two tracheastomies.In group B,there was no complication in any of the 50 patients.No severe cardiovascular complication occurred in either group.The incidence of complications in group B was significantly lower than that in group A（P0.05）.Conclusions The perioperative monitoring system can obviously enhance patients′ tolerance to the operation/anesthesia,strengthen the treatment,and reduce the operative risks in patients with OSAHS.