60例改良腭咽成形术围手术期并发症处理

目的总结60例阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypop-nea syndrome,OSAHS）的麻醉、手术并发症及防治对策。方法 60例OSAHS患者均行改良腭咽成形术,其中6例同期行舌骨悬吊术。结果麻醉诱导致急性呼吸衰竭1例经抢救成功,原发性出血8例,继发性出血3例,术后短暂呼吸不畅1例,切口裂开10例,短期腭咽关闭不全5例,6例行舌骨悬吊术的患者有2例发生口底水肿,均经相应对症处理症状消失。结论规范的围手术期处理,术前气管切开或CPAP治疗,清醒状态下麻醉插管,重症患者术后延迟拔管等,可有效降低麻醉和手术意外的发生机会。

Countermeasures against perioperative complications in 60 OSAHS patients treated with modified uvulopalatopharyngopasty

Objective To summarize anesthesia and surgical complications in 60 patients suffering from obstructive sleep apnea hypopnea syndrome（OSAHS） treated with modified uvulopalatopharyngopasty and analyse the prevention measures adopted.Methods Of all the 60 cases,modified uvulopalatopharyngoplasty（UPPP） was applied to 5 under local anesthesia and 55 under general anesthesia separately.Meanwhile,6 cases received combined hyoid suspension.Results One patient with acute respiratory failure induced by anesthesia induction was successfully rescued.Postoperative complications included primary hemorrhage（8 cases）,secondary hemorrhage（3 cases）,short breath（1 case）,dehiscence（10 cases）,and short-term velopharyngeal insufficiency（5 cases）.Two of the 6 cases received combined hyoid suspension had mouth floor edema.No long-term operation complications occurred.Conclusion The standard perioperative managements,such as preoperative tracheotomy in advance of UPPP,or CPAP treatment,awake intubation anesthesia,delayed postoperative extubation for severe patients,can effectively avoid the anesthesia and surgical complications in modified UPPP.