阻塞性睡眠呼吸暂停低通气综合征围手术期并发症的预防及处理

目的 总结阻塞性睡眠呼吸暂停低通气综合征（OSAHs）患者围手术期并发症的预防及处理。方法 分析98例OSAHS患者的临床资料，术前高血压、糖尿病及心脏病者均对证治疗。81例选择全麻（82．7％），17例选择局麻（17．3％）。同期或术前1周行气管切开36例，占本组全麻患者的44．44％），其中体重指数超过正常上限29例，最低血氧饱和度〈50％29例，同时行鼻部手术者5例，心脏异常或伴高血压20例。结果 1例局麻下气管切开时出现心率、血氧下降，气管切开待病情稳定后再手术；1例全麻术后拔除气管插管后出现呼吸抑制，重新气管插管；术后创口出血1例，再次全麻止血；短期进食返呛23例（23．5％）。结论 重视OSAHS患者术前检查并对症治疗，以减少术中、术后心脑血管并发症；全麻患者应严格掌握拔管指征，待患者意识完全清醒后拔管；严重肥胖、重度OSAHS最低血氧饱和度〈50％或伴有较重的心血管合并症或同时行鼻部手术者，气管切开术可降低严重并发症的发生。

Prevention and management of perioperative complications of obstructive sleep apnea-hypopnea syndrome

Objective To explore the prevention and management of complications during the perioperative period of obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods Clinical data of 98 patients with OSAHS were analyzed retrospectively.The patients with hypertension,diabetes and cardiac diseases were all treated before uvulapalatopharyngoplasty(UPPP).UPPP was performed under general anesthesia in 81 cases(82.7%) and under local anesthesia in 17 cases(17.3%).Tracheotomy was performed in 36 cases simultaneously or one week before UPPP.Results The heart rate and blood oxygen saturation decreased dramatically in 1 case as tracheotomy was being performed under local anesthesia,and UPPP was then performed when the general condition was stabilized.Respiratory restraint appeared in 1 case after tracheal tube was excubated,and emergent tracheal reintubation combined with artificial respiration was given with successful outcome.The hemostasia was performed under general anesthesia in 1 case owing to bleeding after UPPP.Conclusion More attention should be paid to the preoperative examinations in patients with OSAHS,and systemic disorders should be treated promptly as to reduce or even avoid the cardiovascular and cerebrovsacular complications during and after operation.For the patients receiving UPPP under general anesthesia,tracheal excubation should be done when they completely aroused.To reduce severe complications,tracheotomy is recommended to the obese patients or those with the lowest blood oxygen saturation(<50%),those with severe cardiovascular diseases,and those with the nasal operation performed synchronously.