阻塞性睡眠呼吸暂停低通气综合征舌根等离子射频消融术的并发症  

Complications of tongue base reduction with radiofrequency tissue ablation on obstructive sleep apnea hypopnea syndrome

作　　者：陈金辉[1] 罗志宏[1] 徐红星[2] 杨希林[1] 朱明万[1] 陶泽璋[1] 

机构地区：[1]武汉大学人民医院耳鼻咽喉头颈外科鼾症中心,430060 [2]武汉大学人民医院心内科,430060

出　　处：《中华耳鼻咽喉头颈外科杂志》2010年第7期574-577,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：湖北省自然科学基金项目（2009CDB429）

摘　　要：目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者舌根等离子射频消融术并发症的原因及防治措施.方法 2008年3月至2009年12月经多道睡眠监测确诊的OSAHS患者行舌根等离子射频消融术193例,观察并分析其术中及术后出血、感染、舌根血肿、脓肿、疼痛、味觉改变、舌麻木感、舌体运动障碍、言语及吞咽功能障碍发生情况及处理措施.结果 术中未见并发症.术后疼痛186例（96.4%）,颌下水肿155例（80.3%）,继发性出血1例（0.5%）,夜间猝死1例（0.5%）,无舌黏膜溃疡、味觉改变、舌麻木感、舌根血肿、舌根脓肿、伸舌偏斜、言语及吞咽功能障碍.患者术后疼痛为轻中度,双氯芬酸钠栓可以起到良好的镇痛效果.继发性出血患者的出血量少,对症处理后未再发出血.夜间猝死1例发生在术后37 h,可能是术后局部水肿、疼痛加重睡眠呼吸暂停及夜间低氧血症,诱发心律失常而导致猝死.结论 舌根等离子射频消融术并发症多表现为疼痛、水肿等轻微反应,通过术后使用抗生素、激素及止痛药物可以有效控制.但是对于合并心肺疾病的重度OSAHS患者而言,舌根等离子射频消融术可诱发心源性猝死,应引起高度警惕.Objective To investigate the complications of tongue base reduction with radiofrequency tissue ablation on patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and find out the effective prevention strategies. Methods One hundred and ninety three OSAHS patients diagnosed by polysomnography were received tongue base reduction with radiofrequency tissue ablation between March 2008 and December 2009. The intraoperative and postoperative complications including bleeding, hematoma of tongue base, abscess of tongue base, altered taste, tongue numbness, deviation of tongue extenison movement, dysfunctions of pronunciation and swallowing as well as the managements were analyzed retrospectively. Results No perioperative complications occurred. There were 186 cases with postoperative pain（96.4%）, 155 cases with submandibular edema（80. 3% ）. Nocturnal sudden cardiac death was encountered in 1 case and secondary bleeding in 1 case. There was no ulceration of tongue base mucose,hematoma or abscess of tongue base, altered taste, tongue numbness, tongue deviations, speech, swallowing and taste disorder after operation. The scale of postoperative pain claimed by patients was ranged between mild to moderate. Diclofenac suppository had analgesic effect for these patients. The quantity of bleeding in patient with secondary hemorrhage was so little that after proper treatment the bleeding was stopped and never happened again. Patient with nocturnal sudden cardiac death occurred at thirty-seven hours after operation,because of swelling and pain of tongue base aggravated sleep apnea and night hypoxemia inducing fatal arrhythmia. Conclusions Postoperative pain and submandibular edema were 2 most common postoperative complications which can be easily controlled by antibiotics, Glucocorticoids and Diclofenac suppository. For those severe OSAHS patients accompanied by cardiopulmonary diseases, the tongue base reduction with radiofrequency tissue ablation can induce nocturnal sudden cardiac death. It is important to

关 键 词：睡眠呼吸暂停 阻塞性 舌 导管消融术 手术中并发症 手术后并发症 

分 类 号：R766[医药卫生—耳鼻咽喉科]