CAJ | 학술논문

目的通过阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者手术并发症相关危险因素的分析,探讨并发症防治原则.方法 1998年9月至2007年3月经多道睡眠监测确诊的OSAHS手术患者653例,根据上气道解剖性狭窄的部位及阻塞范围,分别进行悬雍垂腭咽成形术(UPPP)586例次,同时或单纯行鼻腔鼻窦手术104例次,行舌骨悬吊术53例次.在局麻加强化下手术294例,全麻下手术359例.围手术期217例患者行术前3～7 d、术后2～3 d无创正压通气治疗(CPAP).结果 57例(8.7%)OSAHS患者出现各类围手术期并发症93例次,呼吸道并发症19例次,其中全麻诱导期死亡1例;术中大出血9例次,术后出血27例次;心血管并发症31例次,脑出血偏瘫1例;手术后反应性嗜睡3例次,反应性高血糖3例次.多因素Logistic逐步回归分析显示:OSAHS患者围手术期CPAP治疗有利于降低手术并发症的发生,而术前高血压、体重指数、呼吸暂停低通气指数及全麻方式是与手术并发症相关的危险因素.术后均进行1年以上随访,UPPP术后23.9%的患者出现明显的咽喉部异物感,术后6～12个月缓解;咽腔瘢痕粘连7例,腭咽通气道闭锁1例,萎缩性鼻炎、咽炎3例,长期饮食反流3例.结论合并高血压的重症肥胖OSAHS患者围手术期并发症风险增加,有效的血压控制、积极的CPAP治疗、学科间的相互合作和密切的手术后监护,对减少OSAHS患者手术并发症有重要的意义.
목적 통과조새성수면호흡잠정저통기종합정(OSAHS)환자수술병발증상관위험인소적분석,탐토병발증방치원칙.방법 1998년9월지2007년3월경다도수면감측학진적OSAHS수술환자653례,근거상기도해부성협착적부위급조새범위,분별진행현옹수악인성형술(UPPP)586례차,동시혹단순행비강비두수술104례차,행설골현조술53례차.재국마가강화하수술294례,전마하수술359례.위수술기217례환자행술전3～7 d、술후2～3 d무창정압통기치료(CPAP).결과 57례(8.7%)OSAHS환자출현각류위수술기병발증93례차,호흡도병발증19례차,기중전마유도기사망1례;술중대출혈9례차,술후출혈27례차;심혈관병발증31례차,뇌출혈편탄1례;수술후반응성기수3례차,반응성고혈당3례차.다인소Logistic축보회귀분석현시:OSAHS환자위수술기CPAP치료유리우강저수술병발증적발생,이술전고혈압、체중지수、호흡잠정저통기지수급전마방식시여수술병발증상관적위험인소.술후균진행1년이상수방,UPPP술후23.9%적환자출현명현적인후부이물감,술후6～12개월완해;인강반흔점련7례,악인통기도폐쇄1례,위축성비염、인염3례,장기음식반류3례.결론합병고혈압적중증비반OSAHS환자위수술기병발증풍험증가,유효적혈압공제、적겁적CPAP치료、학과간적상호합작화밀절적수술후감호,대감소OSAHS환자수술병발증유중요적의의.
Objective To analyze the surgical complications in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and discuss the risk factors and preliminary strategies for prevention of complications. Methods From September 1998 to March 2007, 653 OSAHS patients confirmed by polysonmography were treated by different surgical approaches according to their obstructive sites, which included uvulopalatopharyngoplasty (UPPP) in 586 cases, nasal surgery in 104 cases/times, hyoid suspension surgery in 53 cases/times, respectively or at the same time. Local anesthesia was used in 294 cases and general anesthesia in 359 cases. Two hundreds and seventeen cases were treated by continuous positive airway pressure (CPAP) 3 to 7 days pre-operation and 2 to 3 days post-operation. Results Peri-operative complications were found in 57 OSAHS cases (93 times), the incidence of peri- operative complications was 8.7% (57/653), including respiratory problems in 19 cases/times and 1 death occurred during inducing stage in general anesthesia. Profuse bleeding was encountered in 9 cases/times during operation and primary and secondary bleeding in 27 cases/times, cardiopathy and hypertension crisis in 31 cases/times and cerebral stroke and hemiplegia in 1 case, reactive somnolence in 3 cases/times and reactive hyperglycemia in 3 cases/times. Data were analyzed by the multivariate logistic regression model. The results showed that the complications were significantly reduced after CPAP treatment during peri-operative stage and increased accompanied with patients' hypertension, choice of general anesthesia, BMI and AHI. All patients were followed-up more than 1 year. After UPPP, 23.9% cases (140/586) had sensation of foreign body in pharynx and alleviated in 6 to 12 months. Scar tissues in oropharynx in 7 cases, nasopharyngeal stenesis in 1 case, atrophy rhinititis and atrophy pharyngitis in 3 cases, nasopharyngeal unclosure and long-term nasopharyngeal reflex in 3 cases. Conclusions Peri-operative complications are more common in obese and severe OSAHS patients, especially when they accompanied with hypertention. The corresponding strategies should be taken to reduce complications in OSAHS surgery, which include controlling the hypertension effectively, performing CPAP treatment actively, cooperating with interdisciplinary doctors, monitoring closely after operation. It is important to reduce surgical sequelaes through improving surgical skills and not enlarging the surgical scale blindly.