Postoperative Respiratory Care On Oral And Maxillofacial Surgery

近年来，由于口腔颌面外科手术所需时间的延长和老年患者数量的增加，比以往更多的患者面临术后呼吸道并发症的风险。将气管纳入手术领域可能会导致术后呼吸并发症，即使在手术前没有呼吸损害的患者也是如此。为了更好地了解口腔大学和牙科学校医院的现状，研究口腔颌面外科术后呼吸功能管理的最佳方法，从而提高我们预测和预防术后呼吸窘迫的能力。共有92.3%的牙科大学和牙科学校医院回答说，术后患者的管理是由牙科麻醉师完成的。AMA…接受全身麻醉的NG患者较多，4.3%的患者麻醉时间长达10小时或更长时间；几乎所有这些患者都接受了恶性肿瘤手术。然而，很少有机构有术后呼吸管理指南，只有不到一半的机构有人工呼吸器。在我们医院，大约4.8%的患者接受了长时间的麻醉。根据Okutsu等人建立的预测术后呼吸道并发症的评分系统进行评估时，这些患者中约有97%的患者患上某些术后呼吸道并发症的风险增加。然而，事实上，任何患者都没有出现严重的并发症。这些并发症显然是通过术后使用人工呼吸器进行呼吸管理来预防的。因此，接受长时间麻醉的患者需要在术后至少24小时内进行丙乳酸人工呼吸。呼吸功能受损尤其出现在老年患者中，即使他们没有接受长时间的手术，他们术后呼吸道并发症的发生率也很高。术后潮气量低于术前，术后肺活量减少30%被认为是预防性人工呼吸的指征。较少

In recent years, more patients than previously are at risk for postoperative respiratory complications because of the prolonged time required for oral and maxillofacial operations and the increasing number of elderly patients. The inclusion of the trachea in the operative field can lead to postoperative respiratory complications, even in patients with no respiratory impairment before operation. However, we have found no report describing criteria for the management of postoperative respiratory function in this field.We sought to obtain a better understanding of the current status at dental colleges and dental school hospitals and to study optimal methods for the management of respiratory function after oral and maxillofacial surgery, thereby improving our ability to predict and prevent postoperative respiratory comlpications.A total of 92.3% of the dental colleges and dental school hospitals responded that postoperative patient management was performed by a dental anesthesiologist. Ama … More ng patients receiveing general anesthesia, 4.3% were anesthetized for prolonged periods of 10 or more hours ; virtually all of these patients underwent surgery for malignant tumors. However, few institutions had guidelines for postoperative respiratory management, and less than half had an artificial respirator.At our hospital, about 4.8% of patients undergo prolonged anesthesia. About 97% of these patients are at increased risk for suffering some postoperative respiratory complication, when assessed aqccording to the scoring system for the prediction of postoperative respiratory complications established by Okutsu et al. In fact, however, no serious complications developed in any patient. Such complications were apparently prevented by postoperative respiratory management with an artificial respirator. Patients who undergo prolonged anesthesia therefore require propgylactic artificial respiration for a minimum of 24 hours after operation. Impaired respiratory function was especially present in elderly patients, who had a high incidence of postoperative respiratory complications even if they did not undergo prolonged operations. Postoperatively, tidal volume was lower than before operation, and a decrease in postoperative vital capacity of * 30% was considered an indication for prophylactic artificial ventilation. Less