Obstructive sleep apnea, continuous positive airway pressure, and surgery.
Obstructive sleep apnea, continuous positive airway pressure, and surgery.
复制标题
阻塞性睡眠呼吸暂停、持续气道正压通气和手术。
DOI：
10.1097/00132586-198912000-00029
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发表时间：
1989
期刊：
影响因子：
--
通讯作者：
G. N. Murcia
中科院分区：
文献类型：
--
作者：
N. Powell;R. Riley;C. Guilleminault;G. N. Murcia
阻塞性睡眠呼吸暂停（OSA）患者接受上气道手术后，如果手术缓解了部分或全部解剖阻塞，则有望改善，或者如果手术未纠正，则继续在术前水平去饱和。病态肥胖、全身麻醉恢复和手术水肿等因素可能导致饱和度低于术前水平。由于这种风险，严重OSA患者被认为是保护性气管切开术。我们的研究结果表明，选择的患者谁将已过去的候选人进行保护性气管切开术，而接受手术的严重OSA，作为一种替代，可以考虑立即术后使用鼻持续气道正压通气（CPAP）。10例选择手术治疗的重度OSA患者在拔管后立即和术后成功地进行了CPAP治疗，以帮助气道通畅和血红蛋白饱和度。术后随访包括连续脉搏血氧饱和度、心脏活动和间歇动脉血气监测。术前，所有10例患者在睡眠期间的氧饱和度下降水平均显著降低，平均最低血氧饱和度（SaO2）为51.5%。手术后，该组所有患者均维持SaO2水平不低于90%，仅在室内空气中使用CPAP时平均SaO2水平为93%（F10（2）21%）。
Patients with obstructive sleep apnea (OSA) who have undergone upper airway surgery could be expected to improve if surgery alleviated some or all of the anatomic obstructions, or continue to desaturate at preoperative levels if the surgery was not corrective. Factors such as morbid obesity, general anesthesia recovery, and operative edema can potentially cause desaturations below preoperative levels. Because of this risk, patients with severe OSA have been considered for protective tracheostomy. The findings of our study suggest that selected patients who would have been past candidates for protective tracheostomy while undergoing surgery for severe OSA can, as an alternative, be considered for immediate postoperative use of nasal continuous positive airway pressure (CPAP). Ten surgical patients with severe OSA who elected surgical treatment were successfully treated with CPAP immediately after extubation and postoperatively to assist with airway patency and hemoglobin saturation. Postoperative followup included monitoring of continuous pulse oximetry, cardiac activity, and intermittent arterial blood gases. Preoperatively, all ten patients had marked decrease in oxygen desaturation levels during sleep, with a mean nadir oxygen saturation (SaO2) to 51.5%. After surgery, all patients in this group maintained SaO2 levels to no lower than 90%, with a mean SaO2 level of 93% while using CPAP on room air (F10(2) 21%) only.