预防性气管切开术在阻塞性睡眠呼吸暂停低通气综合征手术中的应用  

Application of preventive tracheotomy in surgery of obstructive sleep apnea syndrome

作　　者：崔树勋[1] 李长青[1] 李桂芝[1] 金宏林[1] 孟凡丽[2] 

机构地区：[1]吉林大学第二医院耳鼻咽喉科,吉林长春130041 [2]公主岭市中心医院耳鼻咽喉科,吉林公主岭136100

出　　处：《中国耳鼻咽喉颅底外科杂志》2004年第1期33-36,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的　探讨预防性气管切开术在阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapneasyn drome ,OSAS)手术中应用的意义和适应症。方法　回顾性分析 94例手术治疗的OSAS病例。将其按是否行气管切开术分成观察组和对照组。分析病史、术前术后检查、合并症、术后并发症等的差别。采用ROC(relativeoperat ingcharacteristic)曲线法确定预防性气管切开术的适应症。 结果　两组间在体重指数 (bodymassindex ,BMI)、呼吸暂停指数 (apneaindex ,AI)、呼吸暂停低通气指数 (apnea/hypopneaindex ,AHI)、最低血氧饱和度 (thelowestoxygensaturation ,LOS)上有明显差别。结论　气管切开术可有效防止OSAS围手术期致死性并发症的发生。OSAS手术中预防性气管切开术适应症 :①LOS <6 0 %。②AHI≥ 5 0 ,AI≥ 4 0。③重度OSAS合并较严重高血压病、心脏病、慢性阻塞性肺疾病等心血管、肺和脑疾病。④有严重缺氧症状者。⑤体重明显超重 ,BMI≥ 30 ,颈粗短、小下颌、舌根后坠、舌体肥大者。⑥同时行鼻部手术者。Objective A review of patients with obstructive sleep apnea syndrome (OSAS) undergoing uvulopalatopharyngoplasty (UPPP) or palatopharyngoplasty (PPP) with or without previous tracheotomy was performed to determine the significance and indication of tracheotomy in this process. Methods The paper showed the retrospective case review of study group with OSAS undergoing UPPP/PPP with previous tracheotomy and that of control group without previous tracheotomy. Results The differences between the study and control patients were significant in body mass index (BMI), apnea index (AI), apnea/hypopnea index (AHI), and the lowest oxygen saturation (LOS). Conclusion Results support that tracheotomy can effectively avoid the perioperative fatalities of UPPP/PPP. The indications for tracheotomy before UPPP/PPP are: 1. LOS<60%; 2. AHI≥50, AI≥40; 3. severe OSAS complicated with severe hypertension, heart diseases, chronic obstructive pulmonary diseases and cerebrovascular diseases; 4. the symptoms of severe hypoxia; 5. BMI≥30, with short, thick neck, micrognathia, and relative macroglossia; 6. simultaneous nasal operations.

关 键 词：睡眠呼吸暂停综合/外科学 气管切开术 

分 类 号：R766.9[医药卫生—耳鼻咽喉科] R563.8[医药卫生—临床医学]