摘要
目的探讨全身麻醉的睡眠呼吸暂停综合征患者术前无创呼吸机通气对其围术期氧合指标及苏醒质量的影响。方法选取我院2015年1月~2017年3月收治的阻塞性睡眠呼吸暂停综合征患者104例为研究对象,随机分为观察组和对照组,每组52例。术前5~7 d,对照组实施单纯鼻导管给氧,观察组实施无创呼吸机吸氧治疗。两组患者在全身麻醉下行悬雍垂腭咽成型术。术中连续无创监测氧合指标,并记录两组术前(T_(0))、气管插管后30 min(T_(1))、气管插管后1 h(T_(2))、拔除气管导管30 min(T_(3))的血氧分压(PaO_(2))、氧合指数(OI);记录术后1、4、8、12、24、48 h疼痛视觉模拟(VAS)及伯格曼舒适度(BCS)评分;比较治疗前后睡眠有效率、睡眠潜伏期、呼吸暂停低通气指数(AHI)、微觉醒指数;并统计两组患者围拔管期呛咳、呼吸抑制、恶心呕吐、躁动、嗜睡等并发症发生率。结果两组T_(1)、T_(2)、T_(3)时段PaO_(2)和OI水平明显高于T_(0),观察组T_(1)、T_(2)、T_(3)时段PaO_(2)、OI水平高于对照组(均P<0.05)。术后各时间段,观察组VAS评分与对照组无明显差异(P>0.05),术后4、8、12、24 h,观察组BCS评分高于对照组(P<0.05)。观察组治疗后睡眠有效率、睡眠潜伏期与对照组无明显差异(P>0.05),AHI、微觉醒指数明显低于对照组(均P<0.05)。观察组围术期并发症发生率(9.62%)低于对照组(26.92%)(P<0.05)。结论术前无创呼吸机吸通气对睡眠呼吸暂停综合征患者全麻下行悬雍垂腭咽成型术,可在一定程度上改善围术期氧合指标,但对麻醉苏醒质量影响不明显。
Objective To study the effect of preoperative noninvasive ventilator ventilation on oxygenation index and recovery quality of patients with sleep apnea syndrome undergoing general anesthesia.Methods 104 patients with obstructive sleep apnea syndrome admitted to our hospital from January 2015 to March 2017 were selected and randomly divided into observation group and control group,with 52 cases in each group.At 5 to 7 d before surgery,control group was given simple nasal catheter oxygen inhalation,and observation group was treated with non-invasive ventilator oxygen inhalation therapy.The two groups were given uvulopalatopharyngoplasty under general anesthesia.Oxygenation indexes were given intraoperative non-invasive monitoring,and the partial pressure of blood oxygen(PaO_(2))and oxygenation index(OI)before surgery(T_(0)),at 30 min after tracheal intubation(T_(1)),at 1 h after tracheal intubation(T_(2))and at 30 min after tracheal tube removal(T_(3)),the visual analogue scale(VAS)and Bergman comfort scale(BCS)score at 1,4,8,12,24 and 48h after surgery,sleep effective rate,sleep latency,apnea hypopnea index(AHI)and microarousal index before and after treatment were recorded.The incidence rates of complications of cough during periextubation,respiratory depression,nausea and vomiting,agitation and lethargy were counted.Results The levels of PaO_(2)at T_(1),T_(2)and T_(3)in the two groups were significantly higher than those at T_(0)(P<0.05).The levels of OI at T_(1),T_(2)and T_(3)in the two groups were significantly lower than those at T_(0)(P<0.05).The levels of PaO_(2)and OI at T_(1),T_(2)and T_(3)in observation group were higher than those in control group(P<0.05).At each time point after surgery,the VAS score in observation group was comparable to that in control group(P>0.05).At 4h,8h,12h and 24h after surgery,the BCS score in observation group was higher than that in control group(P<0.05).The sleep effective rate and sleep latency in observation group after treatment were comparable to those in control group(P>0.05).The AHI and microarousal index in observation group after treatment were significantly lower than those in control group(P<0.05).The incidence rate of perioperative complications in observation group was lower than that in control group(9.62%vs 26.92%)(P<0.05).Conclusion Preoperative non-invasive ventilator oxygen inhalation therapy for patients with sleep apnea syndrome undergoing remifentanil anesthesia can improve the perioperative oxygenation indexes to a certain extent,but it has no obvious effects on anesthesia recovery quality.
作者
霍苗
王晋平
郑星星
张倩
HUO Miao;WANG Jinping;ZHENG Xingxing;ZHANG Qian(Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710086, China;Department of Otorhinolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an 710086, China;Burn Plastic Surgery and Aesthetic Surgery, Shaanxi Provincial People's Hospital, Xi'an 710086, China)
出处
《西部医学》
2021年第4期525-529,共5页
Medical Journal of West China
基金
陕西省自然科学基础研究计划(2018JM7145)。
关键词
睡眠呼吸暂停综合征
全身麻醉
无创呼吸机
通气
Sleep apnea syndrome
General anesthesia
Non-invasive ventilator
Oxygen inhalation therapy
