Thatcher Gentry W, Maisel Robert H
Department of Otolaryngology, Hennepin County Medical Center and the University of Minnesota, Minneapolis, Minnesota 55415, USA.
Laryngoscope. 2003 Feb;113(2):201-4. doi: 10.1097/00005537-200302000-00001.
To determine the long-term success and morbidity of tracheostomies for patients with severe obstructive sleep apnea.
A retrospective study of patients who have undergone tracheostomy for documented obstructive sleep apnea at Hennepin County Medical Center since 1979.
Retrospective chart review of all tracheostomy patients operated January 1, 1979, to June 30, 1999, were evaluated. Follow-up data from patient records, death certificates, and DMV.
Seventy-nine patients (70 men and 9 women; age range, 25-70 y; mean age, 47 y) received tracheostomies at a regional sleep disorder center. Respiratory distress index ranged from 45 to 146 (mean value, 81). Tracheostomy eliminated obstructive sleep apnea in all cases. Follow-up ranged from 3 months to 20 years (mean period, 8.3 y). In all, 16 patients had decannulation (range, 2 mo to 13 y): 5 of the patients chose continuous positive airway pressure, 3 grew intolerant of their tracheostomy, 3 had obstructive sleep apnea fully resolve after uvulopalatopharyngoplasty, 3 unknown diagnosis for decannulation, 2 had significant weight loss. Morbidity seen within the first year was primarily limited to granulation tissue, infection, and stoma revision. Fourteen deaths were identified. Average age at time of death was 62 years. Five deaths were cardiopulmonary related, four were from cancer, two were from postoperative complications of unrelated surgery, and one was from aspiration. Tracheostomy-related mortality included one postoperative myocardial infarction and one tracheal-innominate fistula.
Severe obstructive sleep apnea and its comorbid conditions are effectively treated in the long term with tracheostomy. Initial management of more frequent complication is well tolerated. Significant morbidity and mortality are low. Chances of obstructive sleep apnea resolution allowing decannulation remain poor.
确定重度阻塞性睡眠呼吸暂停患者气管切开术的长期成功率及发病率。
对自1979年以来在亨内平县医疗中心因确诊阻塞性睡眠呼吸暂停而接受气管切开术的患者进行回顾性研究。
对1979年1月1日至1999年6月30日期间接受气管切开术的所有患者进行回顾性病历审查，并评估患者记录、死亡证明和机动车管理局的随访数据。
79例患者（70例男性和9例女性；年龄范围25 - 70岁；平均年龄47岁）在一家地区性睡眠障碍中心接受了气管切开术。呼吸窘迫指数范围为45至146（平均值81）。气管切开术在所有病例中均消除了阻塞性睡眠呼吸暂停。随访时间为3个月至20年（平均时间8.3年）。共有16例患者拔管（时间范围为2个月至13年）：其中5例患者选择持续气道正压通气，3例患者对气管切开术不耐受，3例患者在悬雍垂腭咽成形术后阻塞性睡眠呼吸暂停完全缓解，3例患者拔管原因不明诊断，2例患者体重显著减轻。第一年出现的并发症主要限于肉芽组织、感染和造口修复。确定有14例死亡。死亡时的平均年龄为62岁。5例死亡与心肺相关，4例死于癌症，2例死于无关手术的术后并发症，1例死于误吸。与气管切开术相关的死亡包括1例术后心肌梗死和1例气管无名动脉瘘。
气管切开术可长期有效治疗重度阻塞性睡眠呼吸暂停及其合并症。对较常见并发症的初始处理耐受性良好。严重的发病率和死亡率较低。阻塞性睡眠呼吸暂停缓解并允许拔管的机会仍然较低。
