Deutzer Juergen
Scripps Mercy Hospital, San Diego, CA 92103, USA.
Crit Care Nurs Q. 2005 Jul-Sep;28(3):293-9. doi: 10.1097/00002727-200507000-00009.
Patients with morbid obesity undergoing gastric bypass surgery present many unique challenges to the healthcare team. Obstructive sleep apnea (OSA) is a common comorbidity in the postoperative gastric bypass patient. The complexity in the management of these patients during and after anesthesia is immense. Anesthetic agents and analgesics increase the severity of symptoms of OSA. Systemic opioid administration depresses the respiratory drive and decreases oxygen saturation. In addition, normal muscle hypotonia during rapid eye movement sleep increases the chance of respiratory complications during the initial postoperative period. Continuous positive airway pressure can effectively treat sleep apnea in the postoperative gastric bypass patient. There are concerns that pressurized air can inflate the stomach and intestines and result in the disruption of the anastomoses of the gastric bypass patient. If weight loss is sufficient, it can lead to an improvement or even cure of symptoms of OSA.
接受胃旁路手术的病态肥胖患者给医疗团队带来了许多独特的挑战。阻塞性睡眠呼吸暂停(OSA)是胃旁路手术后患者常见的合并症。在麻醉期间及之后对这些患者进行管理的复杂性极大。麻醉剂和镇痛药会加重OSA的症状。全身性阿片类药物的使用会抑制呼吸驱动并降低血氧饱和度。此外,快速眼动睡眠期间正常的肌张力减退会增加术后初期呼吸并发症的发生几率。持续气道正压通气可有效治疗胃旁路手术后患者的睡眠呼吸暂停。有人担心加压空气会使胃和肠道膨胀,从而导致胃旁路手术患者的吻合口破裂。如果体重减轻足够,可导致OSA症状改善甚至治愈。