阻塞性睡眠呼吸暂停低通气综合征患者的术后ICU监护

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）术后ICU监测的临床意义。方法348例OSAHS患者，悬雍垂腭咽成形术（UPPP）199例，改良的舌骨悬吊+UPPP 109例，鼻部手术+UPPP 28例，三平面手术4例，颈外进路舌根舌体手术+UPPP 8例。术后全部转入ICU治疗，持续镇静，控制性低血压，监测各项生命体征。结果所有患者ICU监护期间，镇静深度：Ramsay评分6分或SAS评分1分，清醒拔管后顺利转回普通病房。气管插管时间16～62h，平均19h；拔管后观察2h，一切平稳后转回病房。拔管时机：不吸氧SaO2 95%以上，舒张压70～80mmHg，收缩压120～130mmHg，咽部无新鲜出血，吞咽、咳嗽反射正常，意识完全清醒，交流能合作。19例出现咽腔少许渗血，对症、冷敷控制血压后自行消失；5例出现烦躁，血压升高而出血，持续镇静降低血压后控制；无1例重新行创面止血或进手术室止血。3例拔管后出现呼吸困难，紧急行气管切开，其中三平面手术1例，两平面手术2例。结论OSAHS患者术后ICU监护，保留气管插管并延迟拔管，辅以镇静止痛药物，可明显增加术后安全性，减少出血及呼吸道梗阻等严重并发症的发生。

Post-operative ICU monitoring and nursing for patients with OSAHS

To study the clinical sense of post-operative ICU monitoring and nursing for patients with OSAHS. Methods348 patients with OSAHS were included in the present study. Of all patients, 199 underwent uvolopalatopharyngoplasty (UPPP), 109 underwent modified hyoid suspension in combination with UPPP, 28 underwent nasal surgery in combination with UPPP, 4 underwent 3-planar operations and 8 underwent cervical pathway tongue root and body surgery. All patients were transferred to ICU wards right after the operations, and continuously sedated and subjected to controlled hypotension. All vital signs were monitored. ResultsDuring the course of ICU monitoring, the Ramsay score was increased to 6 or the SAS score was 1. Patients were transferred back to general wards after analepsia and extubation. The time span of tracheal intubation varied from 16 to 62 hours, with an average of 19.3 hours. After being observed for 2 hours following extubation, patients would be transferred to general wards if no adverse events occurred. 19 patients suffered from mild pharyngeal bleeding and healed after expectant treatment and cold compress; 5 suffered from bleeding because of restlessness and had an elevated blood pressure, and were controlled after sedation and antihypertensive therapy; none had hemostasis or secondary hemostasis operations. 3 cases (1 had 3 planar surgeries and 2 had 2 planar surgeries) suffered a dyspnea after extubation and were subjected to emergency tracheotomies. ConclusionsOSAHS patients should be treated by post-operative ICU monitoring, retaining tracheal canulas and delayed extubation as well as sedating and analgesic drugs, so as to lower the rate of serious complications such as bleeding and airway tract obstruction.