气道管理流程在儿童阻塞性睡眠呼吸暂停低通气综合征患者加速康复中的应用

doi:10.6040/j.issn.1671-7554.0.2019.750

摘要/Abstract

摘要： 目的在加速康复外科(ERAS)理念指导下,耳鼻咽喉科联合变态反应科共同建立儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者术前气道管理流程,分析儿童OSAHS患者围术期肺功能情况以及气道干预前后肺功能改善情况,为儿童OSAHS围术期气道管理在ERAS中的作用提供临床依据。方法根据患者既往有无下气道疾病史、术前危险因素、术前肺功能检查等因素联合变态反应科建立儿童OSAHS患者术前肺功能评估及气道管理流程,对2017年11月至2018年12月期间483例儿童OSAHS患者按照该流程评估入院肺功能,对肺功能异常的患者给予雾化吸入治疗干预,评估腺样体肥大患者的肺功能改善情况,并观察患者术中及术后气道不良事件发生情况。结果 483例儿童OSAHS患者严格按照气道管理流程实施,入院肺功能评估发现有56例患者合并哮喘,有62例患者存在肺功能异常,其中限制性通气功能障碍者有13例;阻塞性通气功能障碍者有24例;小气道功能障碍者有41例;支气管舒张实验阳性者有36例。对肺功能异常的患者给予雾化吸入治疗后复查肺功能主要指标较入院时均改善,差异具有统计学意义(P均<0.05),可耐受全麻手术。所有患者按照围术期气道管理流程,术中及术后未出现气道不良事件。结论气道管理流程的建立能够明显改善儿童OSAHS患者的术前肺功能,降低围术期风险,有利于手术顺利实施及患者加速康复。

关键词: 阻塞性睡眠呼吸暂停低通气综合征, 儿童, 加速康复外科, 气道管理, 肺功能, 围术期

Abstract: Objective To establish the preoperative airway management protocol for children with obstructive sleep apnea hypopnea syndrome(OSAHS)by departments of otolaryngology and allergy under the guidance of enhanced recovery after surgery(ERAS)concept, analyze the perioperative pulmonary function of pediatric OSAHS patients and the improvement of pulmonary function before and after airway intervention, so as to provide a clinical basis for the role of airway management of pediatric OSAHS in ERAS. Methods The preoperative pulmonary function evaluation and airway management process of pediatric OSAHS patients was established according to the previous history of lower airway diseases, preoperative risk factors, preoperative pulmonary function and other factors. During Nov. 2017 and Dec. 2018, 483 pediatric OSAHS patients pulmonary function was assessed according to this procedure. Children with abnormal pulmonary function were interfered with atomization inhalation treatment, children with adenoid hypertrophic re- 山东大学学报 (医学版)57卷9期 -郭静,等.气道管理流程在儿童阻塞性睡眠呼吸暂停低通气综合征患者加速康复中的应用 \=-ceived pulmonary function evaluation, and intraoperative and postoperative airway adverse events were observed. Results Of the 483 children, 56 had complicated asthma, 62 had abnormal pulmonary function, including 13 cases with restricted ventilatory dysfunction, 24 had obstructive ventilation dysfunction, 41 had small airway dysfunction and 36 had positive results of bronchodilation test. Children with abnormal lung function showed significant improvement after atomization inhalation treatment (P<0.05), and could well tolerate general anesthesia. All children followed the perioperative airway management process, and no adverse airway events occurred during and after operation. Conclusion The establishment of airway management process can significantly improve the preoperative lung function of children with OSAHS, reduce perioperative risks, facilitate the smooth operation and accelerate the recovery of children.

Key words: Obstructive sleep apnea hypopnea syndrome, Children, Enhanced recovery after surgery, Airway management, Lung function, Perioperative period

中图分类号:

R766.3

郭静, 张宇,杨玉娟,孙月眉,刘丽萍,宋西成. 气道管理流程在儿童阻塞性睡眠呼吸暂停低通气综合征患者加速康复中的应用[J]. 山东大学学报 (医学版), 2019, 57(9): 54-58.

GUO Jing, ZHANG Yu, YANG Yujuan, SUN Yuemei, LIU Liping, SONG Xicheng. Establishment of airway management protocol based on ERAS for OSAHS children[J]. Journal of Shandong University (Health Sciences), 2019, 57(9): 54-58.

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