CAJ | 학술논문

目的评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者肌松时上气道平面塌陷的特点.方法接受悬雍垂腭咽成形术男性OSAHS患者30例,年龄20～59岁,BMI 21 ～ 36 kg/m2,ASA分级Ⅱ或Ⅲ级,呼吸暂停低通气指数28～ 102次/h.静脉注射咪达唑仑1 mg和舒芬太尼5 μg,慢诱导,完成经鼻气管内插管后静脉注射异丙酚0.5 mg/kg和维库溴铵0.08 mg/kg.靶控输注异丙酚和瑞芬太尼维持麻醉.完全肌松后使用连接图像工作站的纤维鼻咽喉镜,定标测量阻塞段长度和记录咽腔不同气道平面的塌陷情况.给予咽腔内正压(3～ 20 cm H2O),逐步增加压力(每次增加1 cmH2O),记录随压力升高不同气道平面的截面积和软腭后区的临界开放压力.结果完全肌松后,硬腭平面完全塌陷的1例(3％),软腭悬雍垂平面完全塌陷30例(100％),舌咽平面完全塌陷23例(77％).1例患者硬腭平面阻塞；其余患者均为软腭后区气道阻塞,阻塞段长度16±9 mm.咽腔内压力每增加1cmH2O,硬腭平面截面积增加(10±4) mm2,软腭悬雍垂平面截面积增加(28±18)mm2.临界开放压力范围3～18 cmH2O,90％患者临界开放压力≤15 cmH2O.结论软腭悬雍垂平面是OSAHS患者肌松时上气道最易塌陷的部分,90％患者的临界开放压力不超过15 cm H2O.
목적 평개조새성수면호흡잠정저통기종합정(OSAHS)환자기송시상기도평면탑함적특점.방법 접수현옹수악인성형술남성OSAHS환자30례,년령20～59세,BMI 21 ～ 36 kg/m2,ASA분급Ⅱ혹Ⅲ급,호흡잠정저통기지수28～ 102차/h.정맥주사미체서륜1 mg화서분태니5 μg,만유도,완성경비기관내삽관후정맥주사이병분0.5 mg/kg화유고추안0.08 mg/kg.파공수주이병분화서분태니유지마취.완전기송후사용련접도상공작참적섬유비인후경,정표측량조새단장도화기록인강불동기도평면적탑함정황.급여인강내정압(3～ 20 cm H2O),축보증가압력(매차증가1 cmH2O),기록수압력승고불동기도평면적절면적화연악후구적림계개방압력.결과 완전기송후,경악평면완전탑함적1례(3％),연악현옹수평면완전탑함30례(100％),설인평면완전탑함23례(77％).1례환자경악평면조새；기여환자균위연악후구기도조새,조새단장도16±9 mm.인강내압력매증가1cmH2O,경악평면절면적증가(10±4) mm2,연악현옹수평면절면적증가(28±18)mm2.림계개방압력범위3～18 cmH2O,90％환자림계개방압력≤15 cmH2O.결론 연악현옹수평면시OSAHS환자기송시상기도최역탑함적부분,90％환자적림계개방압력불초과15 cm H2O.
Objective To investigate the characteristics of upper airway collapse in patients with obstructive slcep apnea hypopnea syndrome (OSAHS) when muscle is fully relaxed.Methods Thirty male ASA Ⅱ or Ⅲ patients with OSAHS aged 20-59 yr with body mass index 21-36 kg/m2 and apnea-hypopnea index (AHI) of 28-102times/h were studied.The patients were sedated with iv midazolam 1 mg and sufentanil 5 μg.Nasotracheal intubation was then performed under topical anesthesia with 1％ dicaine.After confirmation of correct position of nasotracheal tube,anesthesia was induced with propofol 0.5 mg/kg and vecuronium 0.08 mg/kg and maintained with target-controlled infusion of propofol and remifentanil.BIS was maintained at 40-60.Fiberopticnasopharyngoscope and pressure transducer were inserted via contralateral nasal cavity and connected with imaging workstation.The site and length of the obstruction were measured and calibrated.Positive pressure was applied to the pharyngeal cavity and gradually increased in increments of 1 cm H2O until 20 cm H2O.The change in cross-section area and critical opening pressure at different planes in pharyngeal cavity were recorded.Results Complete obstruction occurred at the plane of hard palate in one patient (3％).The soft palate and uvula completely collapsed in all 30 patients (100 ％).The collapse occurred at tongue level in 23 patients (77 ％).Every 1 cm H2O increase in pressure produced increase in cross-section area by (10 ± 4)mm2 at the level of hard palate and by(28 ± 18) mm2 at the level of soft palate and uvula.The critical opening pressure ranged from 3 to 18 cm H2O and was≤ 15 cm H2O in 90％ patients.Conclusion Soft palate and uvula collapse in all patients with OSAHS when muscle is fully relaxed.The critical opening pressure is ≤ 15 cm H2O in 90％ patients.