CAJ | 학술논문

目的总结阻塞性睡眠呼吸暂停低通气综合征(OSAHS)围手术期严重并发症的处理经验,观察干预措施对降低围手术期严重并发症的作用.方法回顾性分析沈阳军区总医院和辽宁省金秋医院923例手术治疗的OSAHS临床资料,根据围手术期是否采取系统干预措施将资料分为两个时段,1995年1月到2002年12月为未采取干预措施的第一时段(402例),2003年1月到2009年12月为采取干预措施的第二时段(521例).总结15年间出现的严重并发症的处理经验,分别比较两个时段单纯悬雍垂腭咽成形术(UPPP)手术以及第二时段内单纯UPPP手术和多平面手术严重并发症发生率的差异.结果第一和第二时段采用单纯UPPP治疗患者分别为387例和390例,组间均衡性检验证实数据有可比性.单纯UPPP手术的患者中,第一时段发生急性呼吸道梗阻5例均救治成功,第二时段无急性呼吸道梗阻患者,差异有统计学意义(直接概率法,P<0.05);第一时段严重术后出血16例,第二时段5例,均经重新全麻手术成功止血,两时段差异有统计学意义(直接概率法,P<0.05).第二时段内单纯UPPP手术和多平面手术均没有急性呼吸道梗阻患者;严重术后出血分别为5例和1例,差异无统计学意义(直接概率法,P>0.05).另有3例舌根扁桃体切除的患者术中发生难以控制的持续创面渗血,以下咽填塞法成功处置.结论急性呼吸道梗阻和严重出血是OSAHS围手术期的严重并发症,及时抢救,正确处理可以获得较好的治疗结果;系统的主动干预措施可以显著减少围手术期严重并发症的发生.
목적 총결조새성수면호흡잠정저통기종합정(OSAHS)위수술기엄중병발증적처리경험,관찰간예조시대강저위수술기엄중병발증적작용.방법 회고성분석침양군구총의원화요녕성금추의원923례수술치료적OSAHS림상자료,근거위수술기시부채취계통간예조시장자료분위량개시단,1995년1월도2002년12월위미채취간예조시적제일시단(402례),2003년1월도2009년12월위채취간예조시적제이시단(521례).총결15년간출현적엄중병발증적처리경험,분별비교량개시단단순현옹수악인성형술(UPPP)수술이급제이시단내단순UPPP수술화다평면수술엄중병발증발생솔적차이.결과 제일화제이시단채용단순UPPP치료환자분별위387례화390례,조간균형성검험증실수거유가비성.단순UPPP수술적환자중,제일시단발생급성호흡도경조5례균구치성공,제이시단무급성호흡도경조환자,차이유통계학의의(직접개솔법,P<0.05);제일시단엄중술후출혈16례,제이시단5례,균경중신전마수술성공지혈,량시단차이유통계학의의(직접개솔법,P<0.05).제이시단내단순UPPP수술화다평면수술균몰유급성호흡도경조환자;엄중술후출혈분별위5례화1례,차이무통계학의의(직접개솔법,P>0.05).령유3례설근편도체절제적환자술중발생난이공제적지속창면삼혈,이하인전새법성공처치.결론 급성호흡도경조화엄중출혈시OSAHS위수술기적엄중병발증,급시창구,정학처리가이획득교호적치료결과;계통적주동간예조시가이현저감소위수술기엄중병발증적발생.
Objective To summarize experiences of serious perioperative complications management of obstructive sleep apnea hypopnea syndrome (OSAHS) , and evaluate the effect of intervention in decreasing the incidence of serious complications. Methods Retrospective analysis of clinical data in Shenyang General Hospital of PLA and Liaoning Province Jinqiu Hospital of OSAHS surgery cases from January 1995 to December 2009 were included in this study, patients were divided into two groups according to with or without intervention. Experience and lessons were analyzed. Results Patients without and with intervention were 402 and 521 respectively, and uvulopalatopharyngoplasty (UPPP) cases in each group were 387 and 390. Five patients in the first group who accepted UPPP had breathing difficulty and were all successfully rescued, while no one in the second group had breathing difficulty. The difference was significant (P<0. 05). Sixteen patients in the first group had severe bleeding after UPPP, while only 5 patients had the severe bleeding in the second group. The difference was significant, too P <0. 05. No breathing difficulty cases in the second group, and serious bleeding cases in each group was 5 and in 1, there was no significant difference (P > 0. 05 ). Conclusions Breath difficulty and serious bleeding are serious perioperative complications of OSAHS surgery, and with systemic intervention the incidence of the complications can be decreased.