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【摘要】： 目的：應用便攜式血氧儀監(jiān)測阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)患者懸雍垂腭咽成形術(UPPP)術前術后夜間血氧飽和度相關指標,評價術后血氧飽和度改善的近期療效并觀察術后第二天到第六天夜間血氧飽和度相關指標變化趨勢。 方法：對來我科以“睡眠時打鼾、伴明顯憋氣”就診的病人,根據(jù)多導睡眠監(jiān)測(PSG)結果,符合中華醫(yī)學會OSAHS診斷標準并具有手術指征的31例患者進行UPPP手術,將其術前一晚及術后第二天至第六天每晚佩戴便攜式血氧儀所監(jiān)測得到的氧減指數(shù)(ODI),最低血氧飽和度(LO2),平均血氧飽和度(AO2),血氧飽和度分別處于90%-99%、80%-89%、70%-79%等區(qū)間的事件數(shù)(分別記錄為Q(90-99)%、Q(80-89)%、Q(70-79)%),血氧飽和度分別低于90%、80%、70%的記錄時間占總記錄時間的百分比(T90%、T80%、T70%)等數(shù)據(jù)分組并進行統(tǒng)計學處理。 結果：31例患者術后均感癥狀有不同程度的改善。輕度OSAHS組中平均血氧飽和度(AO2)和血氧飽和度低于90%的記錄時間占總記錄時間的百分比(T90%)兩指標術前與術后第二到第六天每天夜間相比存在統(tǒng)計學意義。中度OSAHS組中除血氧飽和度處于70%-79%區(qū)間的事件數(shù)(Q(70-79)%)、血氧飽和度低于70%的記錄時間占總記錄時間的百分比(T70%)和最低血氧飽和度(LO2)外,其余各血氧飽和度指標術前和術后每晚存在統(tǒng)計學意義,絕大部分指標存在顯著性差異(p0.01)。重度OSAHS組中,除最低血氧飽和度(LO2)和血氧飽和度處于90%-99%區(qū)間的事件數(shù)Q(90-99)%外,其余各血氧飽和度指標術前術后有顯著性差異(p0.01)。血氧飽和度各指標在術后各天之間尚不能認為有差異,術后5天血氧飽和度各指標變化波動性很大,無明顯規(guī)律性。輕度、中度、重度組各組間術后各指標比較,無統(tǒng)計學意義,尚不能認為各組間有差異。31例患者中共有24例術后最低血氧飽和度達到40%,其中輕度組5例,中度組8例,重度組患者術后最低血氧飽和度均達到此值,共11例。在這24例患者中有19例出現(xiàn)術后有3天最低血氧飽和度達到40%,其中輕度組3例,中度組7例,重度組9例。 結論：OSAHS患者UPPP術后多數(shù)血氧飽和度指標較術前有明顯改善。輕度、中度、重度三組OSHAHS患者術后5天各血氧飽和度指標在三組間比較無統(tǒng)計學差異。血氧飽和度各指標在術后第2到第6天夜間變化波動性很大,無明顯規(guī)律性,絕大多數(shù)患者出現(xiàn)術后重度缺氧情況,最低血氧飽和度達到40%。術后夜間絕大多數(shù)患者缺氧癥狀仍然存在,有窒息危險性,術后進行連續(xù)夜間血氧飽和度監(jiān)測是必要的。
[Abstract]:Objective: to monitor the nocturnal oxygen saturation in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after uvulopalatopharyngoplasty (UPPP) by using portable oxygen analyzer. Objective: to evaluate the short-term effect of the improvement of blood oxygen saturation after operation and to observe the change trend of the indexes of oxygen saturation at night from the second day to the sixth day after operation. Methods: according to the results of polysomnography (PSG), 31 patients who were treated with "snoring during sleep with obvious holding of breath" were performed UPPP operation according to the diagnostic criteria of OSAHS of the Chinese Medical Association and the indication of operation. The lowest oxygen saturation (LO2), mean oxygen saturation (AO2), and oxygen saturation (O _ 2) of (ODI), which were monitored by a portable oxygen meter, were measured between 90 and 99, respectively, one night before operation and from the second day to the sixth day after operation. The number of events (Q (90-99)%, Q (80-89%, Q (70-79%) and the saturation of oxygen in the blood were below 90% and 80%, respectively. Data such as 70% of the total recording time (T90 and T80 and T70%) were grouped and processed statistically. Results: sensory symptoms were improved in 31 patients after operation. The mean oxygen saturation (AO2) and the percentage of recording time less than 90% of the total recording time (T90%) in the mild OSAHS group were statistically significant before and after the second to sixth day of operation. In the moderate OSAHS group, except for the number of events with oxygen saturation between 70% and 79% (Q (70-79)%, the percentage of recording time below 70% (T70%) and the lowest oxygen saturation (LO2) in the moderate OSAHS group, The other indexes of oxygen saturation were statistically significant before and after operation, and there were significant differences in most of them (p0.01). In severe OSAHS group, except for the lowest oxygen saturation (LO2) and the event number Q (90-99)% between 90% and 99%, there was a significant difference between the other indexes of oxygen saturation before and after operation (p0.01). The indexes of blood oxygen saturation could not be considered to be different between the days after operation. On the 5th day after operation, the changes of the indexes of blood oxygen saturation were very volatile and had no obvious regularity. There was no significant difference between the three groups. Among the 31 patients, 24 cases had the lowest oxygen saturation after operation, 5 cases in the mild group, 8 cases in the moderate group, and 5 cases in the mild group, 5 cases in the moderate group, and 8 cases in the moderate group. In the severe group, 11 patients (11 cases) had the lowest oxygen saturation after operation. Of the 24 patients, 19 had the lowest oxygen saturation of 40 at 3 days after operation, including 3 mild, 7 moderate and 9 severe. Conclusion: most of the blood oxygen saturation indexes after UPPP in OSAHS patients were significantly improved compared with those before operation. There was no significant difference in the indexes of oxygen saturation between the three groups on the 5th day after operation in mild, moderate and severe OSHAHS patients. During the second to sixth days after operation, the indexes of oxygen saturation varied greatly and had no obvious regularity. Most of the patients had severe anoxia after operation, and the lowest oxygen saturation reached 40. The anoxia symptoms still exist in most of the patients after operation and are at risk of asphyxia. It is necessary to monitor the blood oxygen saturation continuously after operation.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R766

【參考文獻】

相關期刊論文 前6條

1 侯靜,葛慶崗,何偉,周華,李彤,許元;咪唑安定對重度OSAS術后帶氣管插管患者的鎮(zhèn)靜研究[J];耳鼻咽喉-頭頸外科;2002年05期

2 黃慧敏,朱也森;阻塞性睡眠呼吸暫停綜合征患者的圍術期管理[J];上海口腔醫(yī)學;2003年03期

3 文連姬;辛丁;蘇凱;富東娜;楊景樸;禹桂賢;鄭國勝;李桂芝;;阻塞性睡眠呼吸暫停低通氣綜合征圍手術期并發(fā)癥的預防及處理[J];中國耳鼻咽喉顱底外科雜志;2007年01期

4 王蓓,邢景才,韓長旭,王崇剛,劉卓拉,張荷花,宋滿景,張永興,侯紫娟,段世菊;太原市睡眠呼吸暫停低通氣綜合征的流行病學調(diào)查[J];中華結核和呼吸雜志;2004年11期

5 張慶,何權瀛,杜秋艷,龐桂芬,趙立雙,吳瑞芹,韓芳,劉李承,王英,孫桂香,劉曉燕,趙志偉;承德市區(qū)居民睡眠呼吸暫停低通氣綜合征患病率入戶調(diào)查[J];中華結核和呼吸雜志;2003年05期

6 上海市醫(yī)學會呼吸病學分會睡眠呼吸疾病學組;上海市30歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學調(diào)查[J];中華結核和呼吸雜志;2003年05期

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