腹腔镜Roux-en-Y胃旁路术后即刻持续气道正压通气：安全吗？

Continuous positive airway pressure in immediate postoperative period after laparoscopic Roux-en-Y gastric bypass: is it safe?

作者信息

Ramirez Alexander, Lalor Peter F, Szomstein Samuel, Rosenthal Raul J

机构信息

Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.

出版信息

Surg Obes Relat Dis. 2009 Sep-Oct;5(5):544-6. doi: 10.1016/j.soard.2009.05.007. Epub 2009 Jun 23.

DOI:10.1016/j.soard.2009.05.007

PMID:19640798

Abstract

BACKGROUND

Obstructive sleep apnea is a common condition in the morbidly obese population. Many patients undergoing bariatric surgery require postoperative continuous positive airway pressure (CPAP) therapy. Few data have been published evaluating gastrointestinal anastomotic morbidity in patients receiving CPAP therapy immediately after laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of the present study was to examine the short-term morbidity of postoperative CPAP in patients after LRYGB in a research setting.

METHODS

We retrospectively reviewed a prospectively collected database of 310 patients who underwent LRYGB from June 2005 to August 2006. The hospital and office charts and respiratory treatment records were reviewed from the completion of surgery until the first postoperative visit at 2 weeks. The data collected included age, gender, body mass index, presence of obstructive sleep apnea, in-patient CPAP use, and perioperative complications. Patients were divided into 2 groups: those who used immediate postoperative CPAP therapy and those who did not. Patients requiring revisional surgery and other bariatric procedures were excluded from the present series.

RESULTS

Postoperative CPAP was required by 91 patients (29.3%) and 219 did not use CPAP (70.7%). The mean patient age was 47.2 and 43.9 years (P <.01), and the average body mass index was 52 and 46.4 kg/m(2) in the groups that did and did not require CPAP postoperatively, respectively (P <.0001). No anastomotic leaks occurred in either group, and the most common in-hospital complication, seen in 7 patients (2.2%), was basal atelectasis (3 in the postoperative CPAP group; P >.05), followed by wound infection in 4 patients overall (1.2%; 3 patients in the postoperative CPAP group; P >.05) and gastrointestinal bleeding in 1 patient (.32%) in the group without postoperative CPAP. The difference in overall morbidity, unrelated to the integrity of the anastomosis, between those who used CPAP postoperatively and those who did not was not significant (4.5% versus 3.6%, respectively; P >.05).

CONCLUSION

The use of CPAP after LRYGB did not result in increased the morbidity in our patient series.

摘要

背景

阻塞性睡眠呼吸暂停在病态肥胖人群中是一种常见病症。许多接受减肥手术的患者术后需要持续气道正压通气（CPAP）治疗。关于腹腔镜Roux-en-Y胃旁路术（LRYGB）后立即接受CPAP治疗的患者胃肠道吻合口发病率的评估数据很少。本研究的目的是在研究环境中检查LRYGB术后患者术后CPAP的短期发病率。

方法

我们回顾性分析了2005年6月至2006年8月期间接受LRYGB的310例患者的前瞻性收集数据库。从手术结束到术后2周的首次门诊，对医院和门诊病历以及呼吸治疗记录进行了回顾。收集的数据包括年龄、性别、体重指数、阻塞性睡眠呼吸暂停的存在、住院期间CPAP的使用情况以及围手术期并发症。患者分为两组：术后立即使用CPAP治疗的患者和未使用CPAP的患者。本系列排除了需要再次手术和其他减肥手术的患者。

结果

91例患者（29.3%）术后需要CPAP，219例未使用CPAP（70.7%）。术后需要和不需要CPAP的两组患者的平均年龄分别为47.2岁和43.9岁（P<.01），平均体重指数分别为52kg/m²和46.4kg/m²（P<.0001）。两组均未发生吻合口漏，最常见的院内并发症是基底肺不张，7例患者（2.2%）出现（术后CPAP组3例；P>.05），其次是总体4例患者伤口感染（1.2%；术后CPAP组3例；P>.05），未接受术后CPAP组1例患者胃肠道出血（.32%）。术后使用CPAP和未使用CPAP的患者之间与吻合口完整性无关的总体发病率差异不显著（分别为4.5%和3.6%；P>.05）。