颈椎病合并阻塞性睡眠呼吸暂停综合症前路围手术期麻醉效果观察

Anesthesia effect of anterior cervical surgery for patients with cervical spondylosis with obstructive sleep apnea-hypopnea syndrome

目的探讨颈椎病合并中重度阻塞性睡眠呼吸暂停综合症(obstructive sleep apnea-hypopnea Syndrome,OSAHS)颈前路围手术期麻醉方法及效果。方法对西安交通大学附属红会医院脊柱外科2016年3月至2019年5月期间诊断为颈椎病合并中重度OSAHS行颈前路手术的67例患者进行回顾性分析。中度OSAHS患者为A组(n=32),重度OSAHS患者为B组(n=35)。所有患者均采用清醒纤维支气管镜插管,术中间隔手控呼吸,同时采用有创动脉血压监测,联合右美托咪定、乌拉地尔稳定控制血压;给予舒芬太尼加氟比洛芬酯超前镇痛;术毕采用头高半坐位(约30度),右侧卧15度复苏,送病房或ICU后麻醉医生24 h内定时查房。观察两组患者术后复苏情况,统计呼吸道梗阻、呼吸抑制及气管切开发生率。结果所有患者麻醉及手术均顺利完成;A组患者中30例安返病房,2例患者术后拔管困难送ICU监护观察,1例患者出现延迟呼吸抑制;B组25例患者安返病房,10例患者拔管困难送ICU进一步监护观察,3例患者返回病房后血氧饱和度进行性下降,给予重新插管,送ICU呼吸支持;其中5例患者因呼吸困难行气管切开术,3例患者发生延迟性呼吸抑制。B组患者术后呼吸道梗阻、气管切开发生率明显高于A组患者,差异有统计学意义(P<0.05);呼吸抑制发生率两组之间比较无统计学差异(P>0.05)。结论通过清醒纤维支气管镜插管,间隔手控呼吸,积极控压,头高侧卧位复苏,可以有效降低颈椎病合并阻塞性睡眠呼吸暂停综合症围手术期麻醉风险,重度OSAHS患者建议积极治疗原发疾病再行颈前路手术。

Objective To explore the perioperative anesthesia method of the anterior cervical approach and observe the effect for cervical spondylosis with moderate to severe obstructive sleep apnea-hypopnea syndrome(OSAHS)patients.Methods A retrospective analysis of 67 patients with cervical spondylosis who underwent cervical anterior approach with moderate to severe OSAHS during the period from March 2016 to May 2019 in Honghui Hospital.Patients with moderate OSAHS were divided into group A(n=32),and patients with severe OSAHS were divided into group B(n=35).All patients using awake fiberoptic bronchoscopy combined with interval manual breathing during surgery,while Invasive arterial blood pressure monitoring was used to control the blood pressure by control combined with dexmedetomidine and urapidil;Preemptive analgesia was taken by sufentanil plus flurbiprofen;At the end of the operation,the head was seated at a height of about half(about 30 degrees),and the right side was resuscitated at 15 degrees.After being sent to the ward or ICU,the anesthesiologist regularly checked the patients within 24 hours.Resuscitation of the patients were observed,the incidence of respiratory obstruction、respiratory depression and tracheotomy were counted.Results All patients underwent anesthesia and surgery successfully.30 patients in group A were safely returned to the ward.Two patients were evacuated to the ICU for further monitoring.One patient developed delayed respiratory depression.In group B,25 patients were successfully returned to the ward.10 patients with difficulty in extubation were sent to the ICU for further monitoring.However,three patients returned to the ward developing oxygen saturation decreased progressively were reintubated and sent to the ICU for respiratory support.Five of the patients underwent tracheotomy due to dyspnea,and three patients developed delayed respiratory depression.The incidence of postoperative respiratory obstruction and tracheotomy in group B was significantly higher than in group A(P<0.05).There was no significant difference in the incidence of respiratory depression between the two groups(P>0.05).Conclusion The risk of perioperative anesthesia for cervical spondylosis with obstructive sleep apnea syndrome can effectively reduce by awake fiberoptic bronchoscope intubation,interval manual breathing,active pressure control,head high lateral resuscitation;However,patients with severe OSAHS are advised to actively treat the primary disease before anterior cervical surgery.