中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2013年
4期
406-408
,共3页
尹毅青%Frances Chung%廖埔%赵薇%李成辉
尹毅青%Frances Chung%廖埔%趙薇%李成輝
윤의청%Frances Chung%료포%조미%리성휘
睡眠呼吸暂停,阻塞性%缺氧%手术后并发症%耳鼻喉外科手术
睡眠呼吸暫停,阻塞性%缺氧%手術後併髮癥%耳鼻喉外科手術
수면호흡잠정,조새성%결양%수술후병발증%이비후외과수술
Sleep apnea,obstructive%Anoxia%Postoperative complications%Otorhinolaryngologic surgical procedures
目的 观察阻塞性睡眠呼吸暂停综合征患者咽腭成型术后缺氧发生的风险.方法 阻塞性睡眠呼吸暂停综合征患者46例,年龄30 ～ 50岁,男性,体重指数27～ 33 kg/m2,Mallampati分级Ⅰ-Ⅳ级,ASA分级Ⅱ或Ⅲ级,在异丙酚复合瑞芬太尼全身麻醉下行咽腭成型术.术后鼻导管吸氧24h,监测术后24 h SpO2,记录缺氧指数(ODI,每小时内发生SpO2下降程度≥4%且持续时间≥10 s事件的次数)和SpO2＜ 90%的累计时间百分比(CT90).结果 与术前比较,气管拔管后2h及2～4h、术后第1晚(11:00pm-6:00am) ODI和CT90均明显降低(P＜0.05)；而与气管拔管后2h及2～4h时比较,术后第1晚ODI和CT90均明显升高(P＜0.05).ODI异常率术前为100%,气管拔管后2h和2～4h明显降低(48%、50%,P＜0.05),而术后第1晚却明显升高(86%,P＜0.05),且与术前比较差异无统计学意义(P＜0.05).结论 咽腭成型术虽然可改善阻塞性睡眠呼吸暂停综合征患者的气道梗阻,但术后仍有发生缺氧的风险,不宜作为日间手术处理.
目的 觀察阻塞性睡眠呼吸暫停綜閤徵患者嚥腭成型術後缺氧髮生的風險.方法 阻塞性睡眠呼吸暫停綜閤徵患者46例,年齡30 ～ 50歲,男性,體重指數27～ 33 kg/m2,Mallampati分級Ⅰ-Ⅳ級,ASA分級Ⅱ或Ⅲ級,在異丙酚複閤瑞芬太尼全身痳醉下行嚥腭成型術.術後鼻導管吸氧24h,鑑測術後24 h SpO2,記錄缺氧指數(ODI,每小時內髮生SpO2下降程度≥4%且持續時間≥10 s事件的次數)和SpO2＜ 90%的纍計時間百分比(CT90).結果 與術前比較,氣管拔管後2h及2～4h、術後第1晚(11:00pm-6:00am) ODI和CT90均明顯降低(P＜0.05)；而與氣管拔管後2h及2～4h時比較,術後第1晚ODI和CT90均明顯升高(P＜0.05).ODI異常率術前為100%,氣管拔管後2h和2～4h明顯降低(48%、50%,P＜0.05),而術後第1晚卻明顯升高(86%,P＜0.05),且與術前比較差異無統計學意義(P＜0.05).結論 嚥腭成型術雖然可改善阻塞性睡眠呼吸暫停綜閤徵患者的氣道梗阻,但術後仍有髮生缺氧的風險,不宜作為日間手術處理.
목적 관찰조새성수면호흡잠정종합정환자인악성형술후결양발생적풍험.방법 조새성수면호흡잠정종합정환자46례,년령30 ～ 50세,남성,체중지수27～ 33 kg/m2,Mallampati분급Ⅰ-Ⅳ급,ASA분급Ⅱ혹Ⅲ급,재이병분복합서분태니전신마취하행인악성형술.술후비도관흡양24h,감측술후24 h SpO2,기록결양지수(ODI,매소시내발생SpO2하강정도≥4%차지속시간≥10 s사건적차수)화SpO2＜ 90%적루계시간백분비(CT90).결과 여술전비교,기관발관후2h급2～4h、술후제1만(11:00pm-6:00am) ODI화CT90균명현강저(P＜0.05)；이여기관발관후2h급2～4h시비교,술후제1만ODI화CT90균명현승고(P＜0.05).ODI이상솔술전위100%,기관발관후2h화2～4h명현강저(48%、50%,P＜0.05),이술후제1만각명현승고(86%,P＜0.05),차여술전비교차이무통계학의의(P＜0.05).결론 인악성형술수연가개선조새성수면호흡잠정종합정환자적기도경조,단술후잉유발생결양적풍험,불의작위일간수술처리.
Objective To observe the risks of hypoxemia after uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnea syndrome (OSAS).Methods Forty-six ASA Ⅱ or Ⅲ male patients with OSAS,aged 30-50 yr,with body mass index 27-33 kg/m2,Mallampati Ⅰ-Ⅳ,underwent UPPP under general anesthesia with propofol and remifentanil.O2 was inhaled for 24 h via a nasal catheter starting from the end of surgery.SpO2 was monitored within 24 h after surgery.Oxygen desaturation index (ODI,hourly average number of desaturation episodes in which the decrease in SpO2 ≥4% and duration ≥ 10 s) and the cumulative time percentage with SpO2 ＜ 90% (CT90) from oximetry were recorded.Results Compared with the baseline value before surgery,ODI and CT90 were significantly decreased at 2 and 2-4 h after extubation and on 1 st night after surgery (11:00 pm-6:00 am) (P ＜ 0.05).ODI and CT90 were significantly lower on 1st night after surgery than at 2 and 2-4 h after extubation (P ＜ 0.05).The rate of ODI abnormalities was 100%,48% and 50% before surgery and at 2 and 2-4 h after extubation,respectively.Compared with the baseline value before surgery,the rate of ODI abnormalities was significantly decreased at 2 and 2-4 h after extubation,while increased on 1 st night after surgery (P ＜ 0.05).There was no significant difference in the rate of ODI abnormalities between that on 1 st night after surgery and that before surgery (P ＞ 0.05).Conclusion Although UPPP can significantly improve airway obstruction in patients with OSAS,hypoxemic episodes still occur after surgery,suggesting that UPPP should not be treated as an ambulatory surgery.
