Postoperative Respiratory Care On Oral And Maxillofacial Surgery

近年来，由于口腔颌面手术时间的延长和老年患者的增多，患者面临术后呼吸系统并发症的风险比以往增加。即使在术前没有呼吸障碍的患者中，气管在手术野中的包含也会导致术后呼吸并发症。然而，我们没有发现任何报告描述该领域术后呼吸功能管理的标准。我们试图更好地了解口腔学院和牙科学校医院的现状，并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并发症的能力。92.3%的牙科专科学校和牙科学校医院表示术后患者管理由牙科麻醉师完成。接受全身麻醉的患者中，4.3%麻醉时间延长10小时及以上；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使用人工呼吸器。在我们医院，大约4.8%的病人需要长时间麻醉。根据Okutsu等人建立的预测术后呼吸并发症的评分系统进行评估时，约97%的患者出现术后呼吸并发症的风险增加。然而，事实上，没有任何患者出现严重并发症。术后使用人工呼吸器进行呼吸管理显然可以预防这些并发症。因此，接受长时间麻醉的患者需要术后至少24小时的促乳酸人工呼吸。呼吸功能受损尤其存在于老年患者中，即使他们没有接受长时间的手术，术后呼吸并发症的发生率也很高。术后潮气量低于术前，术后肺活量下降* 30%考虑预防性人工通气指征。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