极度肥胖合并阻塞性睡眠呼吸暂停患者减重代谢手术围术期管理流程  

Perioperative management process for patients with extreme obesity and obstructive sleep apnea undergoing metabolic and bariatric surgery

作　　者：朱冬梓 王文越[1] 王兵[1] 杨珵璨 ZHU Dongzi;WANG Wenyue;WANG Bing;YANG Chengcan(Department of General Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院普外一科,上海200011

出　　处：《中国普通外科杂志》2024年第4期545-552,共8页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(8207031749)。

摘　　要：在拟行减重代谢手术(MBS)的肥胖患者尤其是极度肥胖患者(体质量指数≥50 kg/m^(2))中,阻塞性睡眠呼吸暂停(OSA)最常见、最危重的合并症之一,在减重人群中发病率高达35.0%~93.6%。MBS是唯一能够长期有效治疗极度肥胖同时缓解OSA病情的治疗手段,但OSA也会显著增加MBS围术期呼吸、心血管系统并发症发生率和病死率。为降低MBS围术期风险,针对OSA的围术期管理关键措施在于应在多学科诊治(MDT)基础上及时准确诊断和评估OSA,将OSA的诊疗和监测融入MBS围术期管理流程,规范个性化的精准治疗。本文结合相关文献和笔者单位临床经验,从术前、术中和术后管理三个方面介绍极度肥胖合并OSA的围术期管理流程,为精准评估最有效、安全的治疗方案提供线索和意见。Among obese patients,especially among those with extreme obesity(body mass index ≥50 kg/m^(2)) who are scheduled for metabolic and bariatric surgery(MBS),obstructive sleep apnea(OSA) is one of the most common and s critical comorbidities,with a prevalence ranging from 35.0% to 93.6% in the bariatric population.MBS is the only treatment method capable of providing long-term effective relief for extreme obesity while alleviating OSA symptoms.However,OSA significantly increases the perioperative respiratory and cardiovascular complications and mortality rates associated with MBS.To reduce perioperative risks associated with MBS,key measures for the perioperative management of OSA involve timely and accurate diagnosis and assessment based on a multidisciplinary team(MDT) collaboration.This includes integrating OSA diagnosis,treatment,and monitoring into the perioperative management process of MBS,standardizing personalized precision treatment.This article,drawing on relevant literature and clinical experience from the authors' institution,introduces the perioperative management process for extreme obesity complicated by OSA,covering preoperative,intraoperative,and postoperative aspects,so as to provide clues and insights for the precise assessment of the most effective and safe treatment options.

关 键 词：减肥手术 肥胖症 睡眠呼吸暂停 阻塞性 围手术期医护 

分 类 号：R656.6[医药卫生—外科学]