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目的 :探讨阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)围手术期气管切开的适应证。方法 :对 6 8例重度OSAHS患者采取一系列围手术期治疗。实施术前再诊断、治疗纠正内科并发症 ,持续正压通气 (CPAP)治疗 ,提高手术耐受性。术中认真估量咽腔情况 ,确定切除范围 ,特别是注意将腭咽弓缝合于扁桃体窝 ,扩大咽腔。全麻患者待充分清醒 ,基本恢复正常肌张力后再拔除气管插管。术中、术后适量应用激素。结果 :术前应用经鼻CPAP治疗的 5 1例患者 ,白天困倦消除 ,精力充沛 ,头痛好转 ,17例高血压患者的血压有所下降或降至正常 ,夜间最低血氧饱和度由 (6 3.5 4± 9.45 ) %提高为 (83.32± 8.85 ) %(t =11.5 2 ,P <0 .0 1) ,仅有 1例患者因颈短粗、插管困难而行气管切开术。术前未行经鼻CPAP治疗的 17例患者中 ,2例因过度肥胖行术中气管切开术 ;2例术后感呼吸不畅 ,继续应用CPAP呼吸机治疗。所有患者术后均未出现呼吸道梗阻 ,避免了致死性并发症的发生。结论 :加强围手术期处理 ,可基本避免重度OSAHS患者围手术期气管切开术。
Objective: To investigate the indications of perioperative tracheotomy in obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: A series of perioperative treatment were performed in 68 patients with severe OSAHS. The implementation of preoperative diagnosis, treatment to correct medical complications, continuous positive pressure ventilation (CPAP) treatment to improve surgical tolerance. Severe intraoperative assessment of the pharynx to determine the scope of resection, in particular, pay attention to the palatal pharyngeal suture in tonsil fossa, to expand the pharynx. Patients with general anesthesia to be fully awake, basic recovery of normal muscle tension and then remove the tracheal intubation. Intraoperative and postoperative use of hormones. Results: Fifteen patients undergoing nasal CPAP before operation were relieved of drowsiness during the day, energetic, and had a good headache. The blood pressure of 17 hypertensive patients decreased or dropped to normal, and the nighttime oxygen saturation decreased from 4 ± 9.45)% (83.32 ± 8.85)% (t = 11.5 2, P <0.01). Only 1 patient had tracheotomy due to short neck and intubation. Of the 17 patients who underwent nasal CPAP before surgery, 2 had tracheotomy due to over-obesity, 2 had postoperative respiratory failure, and CPAP was continued. All patients had no postoperative respiratory obstruction, to avoid the fatal complications. Conclusion: Perioperative management can be basically avoided in patients with severe OSAHS perioperative tracheotomy.