摘要
目的分析阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）患者上呼吸道术后第一天夜晚睡眠时脉搏动脉血氧饱和度（arterial oxygen saturation，SaO2）特点，分析影响最低SaO2的因素和监测SaO2的必要性。方法确诊为OSAHS的患者113例，全身麻醉下行改良悬雍垂腭咽成形术（其中46例行同期软腭前移术），术后第一天（手术结束后28．0—36．0h）进行整夜SaO2监测。比较相关指标与术前的变化并分析影响因素。结果113例患者术后第一天夜晚多数患者最低SaO2较术前升高，但其中12例（10．2％）患者最低SaO，较术前下降；1〉0．03氧减指数较术前下降中位数[25分位数；75分位数]为36．9[16．9；52．2]次／h，手术前后比较差异有统计学意义（Z=－9．221，P〈0．001），1例（0．8％）t〉0．03氧减指数较术前上升。无患者出现呼吸系统并发症及术后出血、缺血性心脑血管病等并发症。以满足术前BMI≥27．0kg／m^2、LSaO2〈0．600、AHII〉60．0次／h三个指标中两个指标的患者作为高危组（51例），其他患者作为低危组（62例），高危组术后最低SaO2、睡眠平均SaO2均低于低危组，而≥0．03氧减指数高于低危组，差异均有统计学意义（Z值分别为-4．083、-3．084和-4．593，P值均〈0．01）。结论术后第一天夜晚睡眠时高危OSAHS患者可出现最低SaO2〈0．700，甚至较术前下降，为保证围手术期的安全，对这类患者行睡眠时SaO2监测是必要的。
Objective To investigate the characteristics of overnight arterial oxygen saturation （SaO2） the first day after upper airway reconstruction surgery in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods One hundred and thirteen subjects with OSAHS underwent revised uvulopalatopharyngoplasty （H-UPPP）, among them, 46 subjects underwent same phase transpalataI pharyngoplasty under general anesthesia. After transfered to general ward from intensive care unit the first day after operation they received an overnight hemoglobin-oxygen saturation mornitoring. Results Twelve subjects（ 10. 2% ） had lower lowest SaO2 than preoperative value. ≥ 0. 03 oxygen desaturation index （ ODI3 ） decreased in an median of 36. 9 [ 16. 9 ; 52. 2 ] events/hour compared with preoperative values （ Z = - 9. 221, P 〈 0. 001 ） . One subjects （ 0. 8% ） had increased ODI3. No hemorrhages, cardiovascular complications or airway obstruction occurred. The subjects with any two of the following conditions （n --51） had lower average SaO2, lowest SaO2 and higher ODI3 than the others （n = 62, Z were - 3. 084, - 4. 083 and - 4. 593, P 〈 0. 001 ）. The three subjects were ： （ 1 ） BMI≥ 27.0 kg/m^2 ; （2） Lowest SaO2 〈 0. 600 ; （3） AHI≥60. 0 events/h. Conclusions Some OSAHS patients had a decreased LSaO2 than preoperative values the first day after operation. As part of a patient safety initiative, SaO2 monitoring for those who have high risk for hypoxemia is necessary.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2011年第8期628-631,共4页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
国家自然科学基金（30730100）
北京市自然科学基金（重大项目7100002）
关键词
睡眠呼吸暂停
阻塞性
耳鼻喉外科手术
手术后并发症
血氧测定法
Sleep apnea, obstructive
Otorhinolaryngologic surgical procedures
Postoperative complications
Oximetry
