CAJ | 학술논문

目的通过对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者围手术期急诊事件及危险因素分析,探讨治疗抢救措施及规避策略.方法对2000年1月至2009年12月经浙江省人民医院多导睡眠呼吸监测检查确诊并入院手术治疗的成人患者257例临床资料进行回顾性分析.收集患者一般资料,包括年龄、性别、身高、体重及相关疾病、治疗前AHI及LSaO2、术前处理、麻醉方式、手术方式、术中及术后急诊事件发生的时间,采取的急救措施及转归.根据有无急诊事件的发生,将病例分为急诊事件组(n=19例)和无急诊事件组(n=238例),应用单因素分析和Logistic多元回归分析发生围手术期急诊事件的危险因素.结果围手术期发生急诊事件19例次,发生率为7.3%.单因素分析结果显示发生围手术期急诊事件的相关危险因素包括BMI、相关疾病能否有效控制、AHI、LSaO2,术前CPAP治疗、全身麻醉及同时多部位手术.Logistic多元回归分析提示全身麻醉、同时多部位手术、BMI、AHI是围手术期急诊事件的独立危险因素.术前CPAP治疗是独立保护因素.结论重症OSAHS患者同期多平面全麻手术围手术期风险增加,术前CPAP治疗对降低OSAHS围手术期风险有积极意义.
목적 통과대조새성수면호흡잠정저통기종합정(OSAHS)환자위수술기급진사건급위험인소분석,탐토치료창구조시급규피책략.방법 대2000년1월지2009년12월경절강성인민의원다도수면호흡감측검사학진병입원수술치료적성인환자257례림상자료진행회고성분석.수집환자일반자료,포괄년령、성별、신고、체중급상관질병、치료전AHI급LSaO2、술전처리、마취방식、수술방식、술중급술후급진사건발생적시간,채취적급구조시급전귀.근거유무급진사건적발생,장병례분위급진사건조(n=19례)화무급진사건조(n=238례),응용단인소분석화Logistic다원회귀분석발생위수술기급진사건적위험인소.결과 위수술기발생급진사건19례차,발생솔위7.3%.단인소분석결과현시발생위수술기급진사건적상관위험인소포괄BMI、상관질병능부유효공제、AHI、LSaO2,술전CPAP치료、전신마취급동시다부위수술.Logistic다원회귀분석제시전신마취、동시다부위수술、BMI、AHI시위수술기급진사건적독립위험인소.술전CPAP치료시독립보호인소.결론 중증OSAHS환자동기다평면전마수술위수술기풍험증가,술전CPAP치료대강저OSAHS위수술기풍험유적겁의의.
Objective To analyze the emergency-event in patients with obstructive sleep apnea-hypopnea syndrome( OSAHS), and to discuss the risk factors and preliminary strategies for prevention of emergency-event. Method A total of 257 OSAHS patients in Zhejiang Provincial Peoples Hospital, were enrolled from January 2000 to December 2009 for the retrospective study. Demographics of patients include age, sex,height, weight, related diseases, AHI and LSaO2 before operation , the way of anesthesia and operation,when and how the emergency-events happened, the way to cure and the results. Risk facts of emergency-event were analyzed by using univariate analysis and multiple logistic regression analysis. Results Of the 257patients, the incidents of emergency-event was 7.3%. The independent risk factors of emergency-event were general anesthesia, multiple level surgery in one time, BMI and AHI. Performing CPAP treatment before operation had a beneficial effect to the avoidance of emergency-event. Conclusions Emergency-event are more common in severe OSAHS patients, especially when they were operated under general anesthesia and multiple level surgery in one time. Performing CPAP treatment before operation had a beneficial effect to the avoidance of emergency-event.