阻塞性睡眠呼吸暂停低通气综合征围手术期气管切开适应证探讨

目的 :探讨阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)围手术期气管切开的适应证。方法 :对 6 8例重度OSAHS患者采取一系列围手术期治疗。实施术前再诊断、治疗纠正内科并发症 ,持续正压通气 (CPAP)治疗 ,提高手术耐受性。术中认真估量咽腔情况 ,确定切除范围 ,特别是注意将腭咽弓缝合于扁桃体窝 ,扩大咽腔。全麻患者待充分清醒 ,基本恢复正常肌张力后再拔除气管插管。术中、术后适量应用激素。结果 :术前应用经鼻CPAP治疗的 5 1例患者 ,白天困倦消除 ,精力充沛 ,头痛好转 ,17例高血压患者的血压有所下降或降至正常 ,夜间最低血氧饱和度由 (6 3.5 4± 9.45 ) %提高为 (83.32± 8.85 ) %(t =11.5 2 ,P <0 .0 1) ,仅有 1例患者因颈短粗、插管困难而行气管切开术。术前未行经鼻CPAP治疗的 17例患者中 ,2例因过度肥胖行术中气管切开术 ;2例术后感呼吸不畅 ,继续应用CPAP呼吸机治疗。所有患者术后均未出现呼吸道梗阻 ,避免了致死性并发症的发生。结论 :加强围手术期处理 ,可基本避免重度OSAHS患者围手术期气管切开术。

Reevaluation of the indications for tracheotomy in patients with OSAHS in perioperative period

OBJECTIVE: To reevaluation of the indications for tracheotomy in patients with OSAHS during perioperative period. METHOD: Sixty-eight of 89 patients were severe OSAHS diagnosed with PSG. Perioperative management was taken out, including preoperative rediagnosis, CPAP treatment, treatment of medical complications, confirming the excision area in operation, using steroids to ease postoperative edema, and so on. RESULT: The mean minimum oxygen saturation of 51 patients received preoperative CPAP treatment was increased from (63.54 +/- 9.45)% to (83.32 +/- 8.85)% (t = 11.52, P < 0.01), and only one of them underwent tracheotomy because of severe fat. But two of 17 patients not received preoperative CPAP treatment underwent tracheotomy. No severe upper airway complications occurred. CONCLUSION: Intensive perioperative treatment can avoid tracheotomy in patients with severe OSAHS during perioperative period.