阻塞性睡眠呼吸暂停低通气综合症手术的麻醉期处理

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）手术的麻醉期处理，减少手术麻醉风险。 方法对145例OSAHS患者根据咽部暴露程度进行Mallampati分级。快速气管插管组114例（Ⅰ～Ⅱ级），清醒气管插管组25例（Ⅲ～Ⅳ级），气管切开组6例（清醒气管插管组中体重大于100kg、短颈者）。快速气管插管组术毕待患者完全清醒后拔除气管导管、送监护病房。清醒气管插管组和气管切开组术后送重症监护室监护。 结果快速气管插管组和气管切开组均顺利插入导管，清醒气管插管组7例出现呼吸抑制，面罩辅助呼吸后插入导管。三组均未发生上呼吸道梗阻。快速气管插管组6例拔管时出现恶心、呕吐，8例出现呼吸抑制。 结论降低阻塞性睡眠呼吸暂停低通气综合征手术的围术期风险须重视术前访视，正确选择麻醉诱导方法，加强术中管理、合理选择用药，严格掌握拔管指证，加强术后监护。

Anesthesia for obstructive sleep apnea hypopnea syndrome surgery

To explore the anesthesia management for obstructive sleep apnea hypopnea syndrome(OSAHS) during the operations. Methods145 patients with OSAHS were subjected to the Mallampati classification based on the throat exposure. 114 cases of gradeⅠto Ⅱ were classed to the rapid intubation group, 25 of grade Ⅲ to Ⅳ to the clear intubation group and 6 cases over 100 kg and with short necks and grade Ⅲ to Ⅳ to the tracheotomy group. Patients in the rapid intubation group were subjected to extubation after sobering and sent to the care ward. Patients in the sober intubation group and tracheotomy group were sent to the ICU care. ResultsPatients in the rapid intubation group and tracheotomy group were successfully intubated. 7 cases in the sober intubation group with respiratory depression were successfully intubated after respiratory mask support. None of the three groups had obstructions in the upper respiratory tract. When performing extubation, 6 cases in the rapid intubation group had nausea or vomiting and 8 had respiratory depression. ConclusionTo reduce the peri operative risks, it is important to select a correct induction method, make a pre-operative visit and a reasonable drug choice, grasp the extubation time, and strengthen custody after the operations.