摘要
目的观察阻塞性睡眠呼吸暂停综合征患者咽腭成型术后缺氧发生的风险。方法阻塞性睡眠呼吸暂停综合征患者46例，年龄30～50岁，男性，体重指数27～33kg/m2，Mallampati分级Ⅰ-Ⅳ级，ASA分级Ⅱ或Ⅲ级，在异丙酚复合瑞芬太尼全身麻醉下行咽腭成型术。术后鼻导管吸氧24h，监测术后24hSpO2，记录缺氧指数（ODI，每小时内发生SpO：下降程度≥4％且持续时间≥10s事件的次数）和SpO，〈90％的累计时间百分比（CT90）。结果与术前比较，气管拔管后2h及2～4h、术后第1晚（11：00pm-6：00am）ODI和CTg0均明显降低（P〈0．05）；而与气管拔管后2h及2～4h时比较，术后第1晚ODI和CTg0均明显升高（P〈0．05）。ODI异常率术前为100％，气管拔管后2h和2～4h明显降低（48％、50％，P〈0．05），而术后第1晚却明显升高（86％，P〈0．05），且与术前比较差异无统计学意义（P〈0．05）。结论咽腭成型术虽然可改善阻塞性睡眠呼吸暂停综合征患者的气道梗阻，但术后仍有发生缺氧的风险，不宜作为日间手术处理。
Objective To observe the risks of hypoxemia after uvulopalatopharyngoplasty （UPPP） in pa- tients with obstructive sleep apnea syndrome （OSAS）. Methods Forty-six ASA Ⅱ or Ⅲ male patients with OSAS, aged 30-50 yr, with body mass index 27-33 kg/m2 , Mallampati Ⅰ -Ⅳ , underwent UPPP under general anesthesia with propofol and remifentanil. 02 was inhaled for 24 h via a nasal catheter starting from the end of surgery. SpO2 was monitored within 24 h after surgery. Oxygen desaturation index （ODI, hourly average number of desaturation episodes in which the decrease in SpO2 〉14% and duration ≥ 10 s） and the cumulative time percentage with SpO2 〈 90% （CT90） from oximetry were recorded. Results Compared with the baseline value before surgery, ODI and CT90 were significantly decreased at 2 and 2-4 h after extubation and on 1st night after surgery （11：00 pm-6：00 am） （ P 〈 0.05）. ODI and CT90 were significantly lower on 1st night after surgery than at 2 and 2-4 h after extu- bation （ P 〈 0.05）. The rate of ODI abnormalities was 100% , 48% and 50% before surgery and at 2 and 2-4 h after extubation, respectively. Compared with the baseline value before surgery, the rate of ODI abnormalities was significantly decreased at 2 and 2-4 h after extubation, while increased on 1 st night after surgery （ P 〈 0.05 ） . There was no significant difference in the rate of ODI abnormalities between that on 1 st night after surgery and that before surgery （ P 〉 0.05）. Conclusion Although UPPP can significantly improve airway obstruction in patients with OSAS, hypoxemic episodes still occur after surgery, suggesting that UPPP should not be treated as an ambula- tory surgery.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2013年第4期406-408,共3页
Chinese Journal of Anesthesiology
关键词
睡眠呼吸暂停
阻塞性
缺氧
手术后并发症
耳鼻喉外科手术
Sleep apnea, obstructive
Anoxia
Postoperative complications
Otorhinolaryngologicsurgical procedures
