阻塞性睡眠呼吸暂停综合征患者手术治疗的麻醉研究  

Anesthesia studies in operation of patients with obstructive sleep apnea syndrome

作　　者：刘洪英[1] 蔡晓岚[2] 王娟[3] 魏丽萍[1] 张春丽[1] 许朝霞[1] 朱梓建[1] 范华[1] 

机构地区：[1]济南铁路中心医院,山东济南250001 [2]山东大学卫生部耳鼻喉科学重点实验室 [3]山东大学齐鲁医院

出　　处：《山东大学基础医学院学报》2004年第3期133-136,共4页Journal of Preclinical Medicine College of Shandong Medical University

摘　　要：目的 :探讨阻塞性睡眠呼吸暂停综合征 (obstructivesleepapneasyndrome ,OSAS)患者手术治疗的麻醉处理。方法 :72例OSAS患者手术前先正压通气治疗 (continuepositiveairwaypressure ,CPAP)和评价上气道 ,5 5例患者经鼻或经口气管插管全身麻醉 ;在手术完毕患者完全清醒后拔除插管。结果 :72例患者中 ,轻度 16例、中度 2 4例、重度 32例。合并有晨起高血压 2 8例 ,心电图均有不同程度心肌缺血的表现 ;红细胞增多症 12例 ;腭咽平面Ⅰ级 9例、Ⅱ级 2 4例、Ⅲ级的 2 7例、Ⅳ级 12例。术前 3～ 5d行自动调压正压通气治疗(Auto -CPAP) ,经口气管内插管 4 8例 ,经鼻气管内插管 6例 ,均无术中插管困难和术后高血压危象 ,呼吸道梗阻发生。结论 :充分认识OSAHS患者全身麻醉的手术风险 ,术前CPAP治疗和上气道评估 ,术中正确处理、严格掌握气管内插管、术后拔管的时机 ,是保证OSAHS患者手术成功。Objective:To evaluate the anesthesia management in surgical treatment of the patients with obstructive sleep apnea syndrome (OSAS). Methods: 72 cases with OSAS were treated by continue positive airway pressure (CPAP) and had the evaluation of upper airway. 55 cases who were given general anesthesia had chosen through trans-nasal or trans-oral trachea incubation. It was high time to excubate when patients completely aroused after operation. Results: 72 patients were consisted with slight in 16, middle in 24 and severe in 32 cases. They were combined with morning hypertension in 28 cases who all had different blood deficiency in coronary artery and erythrocytosis in 12 cases. Palatine-pharyngeal level was Ⅰin 9 cases,Ⅱ in 24,Ⅲ in 27 and Ⅳ in 12, respectively. Before operation, Auto-CPAP was treated for 3 to 5 days. Trans-oral incubation was given for 48 cases and trans-nasal for 6 cases. They were not happened about incubation difficulties in surgery and hypertension crisis and obstruction in respiration tract after operation. Conclusion:Surgical dangerous must be fully recognized in general anesthesia to patients with OSAS. It is the key to assure that the patients safely experience the operation and anesthesia through CPAP treatment and upper airway evaluation before operation, correctly management in surgery and strictly mastery the chance of incubation and excubation.

关 键 词：睡眠呼吸暂停 阻塞性 气道 麻醉 治疗 外科 

分 类 号：R766.7[医药卫生—耳鼻咽喉科]