Pang K P
Otolaryngology, Sleep Disorders Unit, Tan Tock Seng Hospital, Singapore, Republic of Singapore.
J Laryngol Otol. 2006 Aug;120(8):655-60. doi: 10.1017/S0022215106001617. Epub 2006 Jun 2.
Potentially serious complications have been documented in patients undergoing upper airway surgery for obstructive sleep apnoea (OSA). Consensus is lacking regarding peri- and post-operative monitoring and identification of those patients likely to suffer post-operative complications. This retrospective review of 118 patients treated and 152 surgical procedures undertaken, from January 1998 to December 2003, addresses this issue. The overall peri- and post-operative complication rate was 13.8 per cent, with one patient experiencing upper airway compromise, five patients experiencing post-operative oxygen desaturation within 150 minutes of extubation, six patients experiencing persistent hypertension and four patients suffering secondary haemorrhage. All patients were treated accordingly and recovered well, with no mortality. From these results, it is concluded that patients with severe OSA (apnoea-hypopnoea index > 60 and lowest oxygen saturation < 80 per cent) are at higher risk of post-operative oxygen desaturation. Post-operative hypertension is more likely in patients with a prior history of hypertension. Routine post-operative admission to an intensive care unit for all OSA patients is unnecessary (including patients with severe OSA). However, all patients with OSA should be closely monitored in the post-anaesthesia care area for at least three hours after surgery; based on the outcome of this period and the clinical judgment of the clinician, the patient can then be observed overnight in either the high dependency unit or on a general ward. Patients with mild OSA may be admitted to the 23-hour ambulatory unit post-operatively. Use of continuous positive airway pressure in the immediate post-operative period can reduce the incidence of post-operative respiratory compromise and complications and is strongly recommended.
已有文献记载，接受上气道手术治疗阻塞性睡眠呼吸暂停（OSA）的患者可能会出现严重并发症。对于围手术期和术后监测以及识别可能发生术后并发症的患者，目前尚无共识。本文对1998年1月至2003年12月期间接受治疗的118例患者和进行的152例手术进行回顾性研究，以解决这一问题。围手术期和术后总体并发症发生率为13.8%，其中1例患者出现上气道梗阻，5例患者在拔管后150分钟内出现术后氧饱和度下降，6例患者出现持续性高血压，4例患者发生继发性出血。所有患者均得到相应治疗且恢复良好，无死亡病例。根据这些结果得出结论，重度OSA患者（呼吸暂停低通气指数>60且最低氧饱和度<80%）术后发生氧饱和度下降的风险更高。有高血压病史的患者术后更易发生高血压。对所有OSA患者常规术后入住重症监护病房是不必要的（包括重度OSA患者）。然而，所有OSA患者术后应在麻醉后护理区域密切监测至少3小时；根据这段时间的结果和临床医生的临床判断，然后可将患者安排在高依赖病房或普通病房过夜观察。轻度OSA患者术后可入住23小时门诊病房。术后立即使用持续气道正压通气可降低术后呼吸功能不全和并发症的发生率，强烈推荐使用。
