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目的探讨预防和处理阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者术中及术后出血的有效方法。方法对2002年3月至2010年12月OSAHS合并高血压行悬雍垂腭咽成形术治疗的75例患者,术前严格剔除非手术适应证,准确确定阻塞部位,将血压、血糖调至正常;术中实施控制性低血压并加强止血处理;术后动态监测血压并持续给予降压药物。结果 2006年前术后未予持续控制血压的47例中,发生术后出血共7例:出现咽腔渗血,经对症、冷敷、控制血压后自行缓解5例;重新进手术室止血2例。2006年后采用术后即持续静脉输注降压药物控制血压的28例患者未发生术后出血。结论对于OSAHS合并高血压患者,加强术前适应证的筛选及血压的调控、术中止血的处理及术后血压的监测和动态控制,可避免或减少术中术后出血等并发症的发生。
Objective To explore an effective method of preventing and treating intraoperative and postoperative bleeding in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) complicated with hypertension. Methods From March 2002 to December 2010, 75 patients undergoing OSAHS with hypertension treated with uvulopalatopharyngoplasty were excluded from the non-surgical indications before operation, and the occlusion sites were accurately identified. Blood pressure and blood glucose were adjusted to normal ; Intraoperative control hypotension and hemostasis; dynamic monitoring of blood pressure and continued administration of antihypertensive drugs. Results Among the 47 patients who had no continuous blood pressure control before and after 2006, there were 7 cases of postoperative hemorrhage: pharyngeal oozing, symptomatic, cold compress and blood pressure control were relieved in 5 cases; 2 cases . No postoperative bleeding occurred in 28 patients who underwent continuous intravenous infusion of antihypertensive drugs to control blood pressure after 2006. Conclusion OSAHS patients with hypertension, to strengthen screening of preoperative indications and blood pressure control, intraoperative hemostasis and postoperative blood pressure monitoring and dynamic control, to avoid or reduce postoperative bleeding and other complications.