Luo Zhi-hong, Chen Shi-ming, Tao Ze-zhang, Cao Yong-mao
Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital, Wuhan University, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2006 Feb;41(2):100-3.
Experiences and lessons of uvulopalatopharyngoplasty (UPPP ) perioperative management, especially causes of postoperative tracheotomy, were analyzed, and related strategy was raised to have a better perioperative management and to avoid tracheotomy.
Two hundred and fifty eight cases of obstructive sleep apnea hypopnea syndromes (OSAHS) diagnosed with polysomnography (PSG) were treated with modified uvulopalatopharyngoplasty (UPPP). The perioperative management was summarized. Patients were divided into two groups according to the perioperative management: without or with perioperative comprehensive management. In group A, there were 32 patients, without comprehensive management, and in group B there were 226 cases with comprehensive management. Sixty eight cases in group B whose apnea hypopnea index over 50 times per hour and the lowest arterial oxygen saturation was less than 0.5 were treated with continuous positive airway pressure (CPAP) for 1 to 3 weeks. For all the 258 cases, perioperative management includes treatment of medical complications, treatment with antibiotics 2 or 3 days before the operation. None of these cases had tracheotomy before surgery.
In group A, three of 32 patients had postoperative tracheotomy, two because of bleeding, and another one because of laryngeal spasm. In group B, none of 226 patients underwent tracheotomy, which owing to modified operative apparatus and effective perioperative and postoperative treatment (chi2 = 21.35, P < 0.001). In group A, 5 of 32 patients had oral pharynx bleeding after 24 hours of the operation. While 26 of 226 patients in group B did so (chi2 = 0.15, P > 0.05).
Comprehensive perioperative management can effectively lower down the complication rate for patients receiving uvulopalatopharyngoplasty.
分析悬雍垂腭咽成形术（UPPP）围手术期管理的经验教训，尤其是术后气管切开的原因，并提出相关策略以优化围手术期管理并避免气管切开。
对258例经多导睡眠图（PSG）诊断为阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的患者行改良悬雍垂腭咽成形术（UPPP），总结围手术期管理情况。根据围手术期管理将患者分为两组：未进行围手术期综合管理组和进行围手术期综合管理组。A组32例，未进行综合管理；B组226例，进行综合管理。B组中68例呼吸暂停低通气指数每小时超过50次且最低动脉血氧饱和度低于0.5的患者，采用持续气道正压通气（CPAP）治疗1至3周。258例患者的围手术期管理包括处理内科并发症，术前2或3天使用抗生素，所有病例术前均未行气管切开。
A组32例患者中有3例术后行气管切开，2例因出血，另1例因喉痉挛。B组226例患者均未行气管切开，这得益于改良的手术器械及有效的围手术期和术后治疗（χ2 = 21.35，P < 0.001）。A组32例患者中有5例术后24小时出现口咽出血，B组226例患者中有26例出现口咽出血（χ2 = 0.15，P > 0.05）。
围手术期综合管理可有效降低悬雍垂腭咽成形术患者的并发症发生率。
