中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2011年
8期
628-631
,共4页
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
睡眠呼吸暫停,阻塞性%耳鼻喉外科手術%手術後併髮癥%血氧測定法
수면호흡잠정,조새성%이비후외과수술%수술후병발증%혈양측정법
Sleep apnea,obstructive%Otorhinolaryngologic surgical procedures%Postoperative complications%Oximetry
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28.0～36.0 h)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SaO2较术前下降;≥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%)≥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 ≥27.0 kg/m2、LSaO2＜0.600、AHI≥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.
目的 分析阻塞性睡眠呼吸暫停低通氣綜閤徵(obstructive sleep apnea hypopnea syndrome,OSAHS)患者上呼吸道術後第一天夜晚睡眠時脈搏動脈血氧飽和度(arterial oxygen saturation,SaO2)特點,分析影響最低SaO2的因素和鑑測SaO2的必要性.方法 確診為OSAHS的患者113例,全身痳醉下行改良懸雍垂腭嚥成形術(其中46例行同期軟腭前移術),術後第一天(手術結束後28.0～36.0 h)進行整夜SaO2鑑測.比較相關指標與術前的變化併分析影響因素.結果 113例患者術後第一天夜晚多數患者最低SaO2較術前升高,但其中12例(10.2%)患者最低SaO2較術前下降;≥0.03氧減指數較術前下降中位數[25分位數;75分位數]為36.9[16.9;52.2]次/h,手術前後比較差異有統計學意義(Z=-9.221,P＜0.001),1例(0.8%)≥0.03氧減指數較術前上升.無患者齣現呼吸繫統併髮癥及術後齣血、缺血性心腦血管病等併髮癥.以滿足術前BMI ≥27.0 kg/m2、LSaO2＜0.600、AHI≥60.0次/h三箇指標中兩箇指標的患者作為高危組(51例),其他患者作為低危組(62例),高危組術後最低SaO2、睡眠平均SaO2均低于低危組,而≥0.03氧減指數高于低危組,差異均有統計學意義(Z值分彆為-4.083、-3.084和-4.593,P值均＜0.01).結論 術後第一天夜晚睡眠時高危OSAHS患者可齣現最低SaO2＜0.700,甚至較術前下降,為保證圍手術期的安全,對這類患者行睡眠時SaO2鑑測是必要的.
목적 분석조새성수면호흡잠정저통기종합정(obstructive sleep apnea hypopnea syndrome,OSAHS)환자상호흡도술후제일천야만수면시맥박동맥혈양포화도(arterial oxygen saturation,SaO2)특점,분석영향최저SaO2적인소화감측SaO2적필요성.방법 학진위OSAHS적환자113례,전신마취하행개량현옹수악인성형술(기중46례행동기연악전이술),술후제일천(수술결속후28.0～36.0 h)진행정야SaO2감측.비교상관지표여술전적변화병분석영향인소.결과 113례환자술후제일천야만다수환자최저SaO2교술전승고,단기중12례(10.2%)환자최저SaO2교술전하강;≥0.03양감지수교술전하강중위수[25분위수;75분위수]위36.9[16.9;52.2]차/h,수술전후비교차이유통계학의의(Z=-9.221,P＜0.001),1례(0.8%)≥0.03양감지수교술전상승.무환자출현호흡계통병발증급술후출혈、결혈성심뇌혈관병등병발증.이만족술전BMI ≥27.0 kg/m2、LSaO2＜0.600、AHI≥60.0차/h삼개지표중량개지표적환자작위고위조(51례),기타환자작위저위조(62례),고위조술후최저SaO2、수면평균SaO2균저우저위조,이≥0.03양감지수고우저위조,차이균유통계학의의(Z치분별위-4.083、-3.084화-4.593,P치균＜0.01).결론 술후제일천야만수면시고위OSAHS환자가출현최저SaO2＜0.700,심지교술전하강,위보증위수술기적안전,대저류환자행수면시SaO2감측시필요적.
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 transpalatal 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. 083and -4.593, P＜0. 001). The three subjects were:(1) BMI≥27.0 kg/m2; (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.
