阻塞性睡眠呼吸暂停低通气综合征行腭咽成形术围手术期的临床研究

目的 :探讨腭咽成形术 (uvulopalatopharyngoplasty ,UPPP)治疗中、重度阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapneahypopneasyndrome ,OSAHS)围手术期的临床处理。方法 :对 5 4例中、重度OSAHS患者实施了腭咽成形术 ,围手术期的处理包括 (1)多道睡眠监测和心肺功能评估 ;(2 )术前 4 4例、术后 2 9例行正压通气治疗 ;(3)静脉诱导吸入全身麻醉 4 6例 ,局部浸润麻醉 8例 ;(4) 4 2例行保留悬雍垂的改良腭咽成形术。结果 :术前未接受CPAP治疗的局麻患者术中出现短暂呼吸困难 2例 ,术后高血压危象、心动过速各 1例 ,术后原发性出血 2例。CPAP治疗组在麻醉清醒期及术后无急性上气道阻塞发生。全身麻醉 5例插管困难 ,有高血压病史的 19例术中血液动力学波动大。经典腭咽成形术后 1周内腭咽关闭不全 4例 ,行保留悬雍垂的改良腭咽成形术后咽部有异物感 9例 ,但无其他并发症。结论 :充分认识UPPP手术存在的潜在风险 ,认真进行围手术期的正确治疗有助于减少手术并发症 ,提高手术和麻醉的安全性

Perioperative period of uvulopalatopharyngoplasty for obstructive sleep apnea hypopnea syndrome

Objective:To explore the treatment of perioperative period of uvulopalatopharyngoplasty(UPPP)in middle or severe obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods:54 cases with OSAHS were treated by UPPP. Perioperative period treatment included:(1)polysomnography and functions of lung and heart;(2) continue positive airway pressure (CPAP)for 44 cases preoperation and 29 cases postoperation; (3) 46 cases with intravenous-inhalation general anesthesia, 8 cases with local anesthesia;(4) 42 cases were performed by preservation of uvula in UPPP. Results:Patients who were treated by local anesthesia and did not have CPAP,(1)temporary dyspnea in 2 cases in operation;(2)1 case with hypertension crisis and 1 case with tachycardia postoperation;(3)primary bleed in 2 cases, but there were not acute airway obstruction in awaking period and postoperation in patients with CPAP. There were 5 cases with difficult intubations in general anesthesia and 19 cases with history of hypertension had more obvious hemodynamic changes in operation. 4 cases with traditional UPPP were presented velopalatal insuddiciency after 1 week of surgery. 9 cases with preservation of uvula in UPPP had some sense of foreign body, but did not have any other complications. Conclusion: Patients with OSAHS in UPPP have great potential dangers. Effective treatment in perioperative period is helpful to reduce surgical complications and elevate the safety of surgery and anesthesia.