重度阻塞性睡眠呼吸暂停低通气综合征行改良悬雍垂腭咽成形术的围术期处理

Perioperative management for severe obstructive sleep apnea hypopnea syndrome in patients treated with modified uvulopalatopharyngoplasty

摘要:

目的 探讨重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apneahypopnea syndrome, OSAHS）患者行改良悬雍垂腭咽成形术（uvulopalatopharyngoplasty， UPPP）围术期处理的必要性及系统性的围术期处理。方法 将274例患者按围术期与否接受系统治疗分为非处理组（A组）与处理组（B组），A组54例患者未做系统性围术期处理；B组220例患者术前予以持续正压通气（continuos positive airway pressure, CPAP）治疗5~7 d，麻醉采用对呼吸肌抑制小及代谢快药物，术后予以非甾体类药物镇痛，ICU监护1~2 d。比较两组术后原发性出血发生率、继发性出血发生率、再插管率、气管切开发生率及术后住院天数。结果A、B组严重并发症发生率分别为20.4%(11/54)，7.3%(16/220)。其中A、B组原发性出血发生率分别为9.3%和2.7%，再插管率为13.0%和0，气管切开发生率5.6%和0.45%，术后住院天数（10.6±2.9）d和（7.7±0.9）d，两组比较差异均具有统计学意义（P均<0.05）；而两组继发性出血发生率为5.6%和4.5%，两组比较差异无统计学意义（P>0.05）。结论系统性围术期处理有助于减少重度OSAHS患者改良UPPP术后严重并发症的发生及促进患者术后恢复。

Abstract:

Objective To discuss the necessity and standardization of perioperative management for severe obstructive sleep apnea hypopnea syndrome (OSAHS) in patients treated with modified uvulopalatopharyngoplasty(MUPPP).Methods274 patients with severe OSAHS were divided into two groups. The patients of group B (n=220) received perioperative management while those of group A(n=54) didn’t. In group B, all the cases received preoperative treatment with continuous positive airway pressure (CPAP) for 5 to 7 days, intraoperative application of anesthetics with weak respiratory depression, and postoperative monitoring in intensive care unit (ICU) for 1 to 2 days and postoperative analgesia with nonsteroidal antiinflammatory drugs. The indexes including primary hemorrhage rate, secondary hemorrhage rate, reintubation rate, tracheotomy rate and the duration of hospitalization after surgery in both groups were collected and compared.ResultsThe rates of serious complication were 20.4% and 7.3% in group A and B respectively. Between the two groups, the differences of primary hemorrhage rate (9.3% vs 2.7%), the reintubation rate (13.0% vs 0.0%), the tracheotomy rate (5.6% vs 0.45%), and the duration of hospitalization after surgery (10.6±2.9 days vs 7.7±0.9 days) were statistically significant (P<0.05), while that of the secondary hemorrhage rate (5.6% vs 4.5%) was insignificant (P>0.05).ConclusionsAppropriate perioperative management can decrease the incidence of serious complication after MUPPP in severe OSAHS patients and promote recovery of the patients.