阻塞性睡眠呼吸暂停低通气综合征患者的术后ICU监护  

Post-operative ICU monitoring and nursing for patients with OSAHS

作　　者：宋西成[1] 张庆泉[1] 夏永宏[2] 刘鲁沂[2] 于鲁欣[2] 王郜[3] 姜秀良[3] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院耳鼻咽喉头颈外科睡眠呼吸中心,山东烟台264000 [2]青岛大学医学院附属烟台毓璜顶医院ICU中心,山东烟台264000 [3]青岛大学医学院附属烟台毓璜顶医院麻醉科,山东烟台264000

出　　处：《山东大学耳鼻喉眼学报》2008年第5期389-392,共4页Journal of Otolaryngology and Ophthalmology of Shandong University

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)术后ICU监测的临床意义。方法348例OSAHS患者,悬雍垂腭咽成形术(UPPP)199例,改良的舌骨悬吊+UPPP 109例,鼻部手术+UPPP 28例,三平面手术4例,颈外进路舌根舌体手术+UPPP 8例。术后全部转入ICU治疗,持续镇静,控制性低血压,监测各项生命体征。结果所有患者ICU监护期间,镇静深度:Ramsay评分6分或SAS评分1分,清醒拔管后顺利转回普通病房。气管插管时间16～62 h,平均19 h;拔管后观察2 h,一切平稳后转回病房。拔管时机:不吸氧SaO295%以上,舒张压70～80mmHg,收缩压120～130 mmHg,咽部无新鲜出血,吞咽、咳嗽反射正常,意识完全清醒,交流能合作。19例出现咽腔少许渗血,对症、冷敷控制血压后自行消失;5例出现烦躁,血压升高而出血,持续镇静降低血压后控制;无1例重新行创面止血或进手术室止血。3例拔管后出现呼吸困难,紧急行气管切开,其中三平面手术1例,两平面手术2例。结论OSAHS患者术后ICU监护,保留气管插管并延迟拔管,辅以镇静止痛药物,可明显增加术后安全性,减少出血及呼吸道梗阻等严重并发症的发生。Objective To study the clinical sense of post-operative ICU monitoring and nursing for patients with OSAHS. Methods 348 patients with OSAHS were included in the present study. Of all patients, 199 underwent uvolopalatopharyngoplasty （UPPP）, 109 underwent modified hyoid suspension in combination with UPPP, 28 underwent nasal surgery in combination with UPPP, 4 underwent 3-planar operations and 8 underwent cervical pathway tongue root and body surgery. All patients were transferred to ICU wards fight after the operations, and continuously sedated and subjected to controlled hypotension. All vital signs were monitored. Results During the course of ICU monitoring, the Ramsay score was increased to 6 or the SAS score was 1. Patients were transferred haek to general wards after analepsia and extuhation. The time span of tracheal intubation varied from 16 to 62 hours, with an average of 19.3 hours. After being observed for 2 hours following extubation, patients would be transferred to general wards if no adverse events oecurred. 19 patients suffered from mild pharyngeal bleeding and healed after expectant treatment and cold compress; 5 suffered from bleeding because of restlessness and had an elevated blood pressure, and were controlled after sedation and antihypertensive therapy; none had hemostasis or secondary hemostasis operations. 3 cases （1 had 3 planar surgeries and 2 had 2 planar surgeries） suffered a dyspnea after extubation and were subjected to emergency tracheotomies. Conclusions OSAHS patients should be treated by post-operative ICU monitoring, retaining tracheal eanulas and delayed extubation as well as sedating and analgesic drugs, so as to lower the rate of serious complicatious such as bleeding and airway tract obstruction.

关 键 词：睡眠呼吸暂停 阻塞性 并发症 悬雍垂腭咽成形术 

分 类 号：R766.7[医药卫生—耳鼻咽喉科]