重度阻塞性睡眠呼吸暂停低通气综合征围手术期持续正压通气治疗  

Periopertive continuous positive airway pressure therapy for severe obstructive sleep apnea hypopnea syndrome patients

作　　者：林忠辉[1] 韩德民[1] 林宇华[1] 张玉焕[1] 王军[1] 陈学军[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉-头颈外科,北京市耳鼻咽喉研究所,北京100730

出　　处：《中华耳鼻咽喉科杂志》2003年第3期172-175,共4页Chinese Journal of Otorhinolaryngology

摘　　要：目的　观察重度阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapneahypopneasyndrome ,OSAHS)围手术期病情变化和持续正压通气治疗 (continuouspositiveairwaypressure,CPAP)的影响 ,探讨围手术期治疗的必要性。方法　 45例重度OSAHS患者均接受了完整保留悬雍垂的改良悬雍垂腭咽成形术。其中 2 4例不做围手术期CPAP治疗的作对照组 ,2 1例行围手术期CPAP治疗 :术前CPAP治疗 7d以上 ,于术后 1～ 3d夜应用自动调节治疗压力的CPAP(autotitratedCPAP ,AutoSet)进行治疗。治疗组患者术后第二夜在AutoSet治疗下同时做多导睡眠监测 (polysomnography,PSG)。对呼吸暂停低通气指数 (apneahyponeaindex ,AHI)、最低血氧饱和度 (lowestSaO2 ,LSaO2 )、血压以及睡眠结构等指标进行观察。结果　对照组 2 4例患者中有 6例于术后第二夜LSaO2 比术前下降 ,AHI升高 ,另外 1 8例患者LSaO2 升高 ,AHI下降。治疗组 2 1例患者CPAP治疗前AHI为 (61 1± 9 9)次 /h( x±s,以下同 ) ,LSaO2 为 65 0 %± 9 6 % ,手术前CPAP治疗后AHI为 (2 2± 1 4)次 /h ,LSaO2 为 94 5 %± 2 9% ,t检验P <0 0 0 1 ;手术前经CPAP治疗临床症状消失。术后患者均能良好耐受AutoSet治疗 ,术后第二夜应用AutoSet治疗时AHI为 (3 6± 1 8)次Objective (1) To investigate the severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients′ perioperative variations of their ploysomnographic indice, to discuss the necessity for their perioperative treatment; (2) To investigate the effects of continuous positive airway pressure (CPAP) on severe OSAHS patients during their periopertive period Methods (1) 21 cases severe OSAHS patients were selected for at least 7 days preoperative CPAP therapy, and this group of patients were also given 3 continuous nights autotitrated CPAP (AutoSet) therapy postoperatively, i e , the first 3 nights after operation The 21 cases were remonitored with PSG during the second night after operation with their AutoSet ON And all the 21 cases had revised uvulopalatopharygoplasty, in which the uvula is reserved completely All patients apnea hyponea index(AHI), lowest SaO 2(LSaO 2), and sleep structure indices were calculated (2) Another 24 cases of severe OSAHS patients without preoperative CPAP therapy or tracheotomy were selected as the control group, all patients received polysomnography (PSG) on the second night postoperatively Results (1)6 cases′ condition of the control group got worse during the second night after operation, their LSaO 2 are lower and their AHI got higher than pre operation For the another 18 cases, their condition got better than before operation (2) 21 cases′ AHI and LSaO 2 are 61 1±9 9, 65 0%±9 6% respectively before CPAP treatment, and the AHI and LSaO 2 are 2 2±1 4, 94 5%±2 9% during CPAP therapy P <0 001 (TTEST) All the 21 cases main symptoms disappeared after 1 week CPAP therapy All 21 cases could tolerate AutoSet treatment well for the first 3 nights after operation During the 2nd night with AutoSet therapy, the AHI and LSaO 2 are 3 6±1 8 and 93 7%±3 4% respectively (3) For the 2nd night after operation, the CPAP and AutoSet treating group′s AHI is lower than that of the control group, also the LSaO 2 is higher, the deep and

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 围手术期 持续正压通气 悬雍垂咽腭成型术 多导睡眠监测 

分 类 号：R766[医药卫生—耳鼻咽喉科]