睡眠呼吸暂停,麻醉医师应知道些什么双语__培训课件.ppt

Preoperative AHI, male gender and 72h opioid dose were positively associated with postoperative AHI.术前的AHI，男性及72h内的阿片类药物的剂量与术后AHI呈正相关 At present, deciding on the optimal level and duration of monitoring for OSA patients remains a daunting challenge.目前，确定OSA患者监测的最佳水平和持续时间仍然是一个艰巨的挑战。 Granted, the incidence of postoperative OSA-related mortality is low; however, it only takes one unnecessary death or one case of hypoxic encephalopathy to be the impetus for closer postoperative monitoring.尽管术后OSA相关死亡率低；为避免不必要的死亡或缺氧性脑病需加强术后监测。 Ambulatory Surgery for OSA Patients OSA患者的门诊手术治疗 The 2006 ASA guidelines on the perioperative management of OSA patients advised that superficial surgery, minor orthopedic surgery under local anesthesia or regional anesthesia, and lithotripsy may be performed as day cases. 2006年ASA针对OSA患者围术期的管理指南建议，浅表手术，轻微的整形外科手术，碎石可当天在局部麻醉或局部麻醉进行 Despite a higher incidence of desaturation and need for supplemental O2 among OSA patients, there was no significant difference in rates of serious adverse outcomes such as reintubation, mechanical ventilation, surgical airway or death. 尽管OSA患者有高的血氧饱和度下降和吸氧需要的概率，但在再插管，机械通气，外科气道或死亡率等严重不良反应上没有显著差异 Known OSA patients with well controlled comorbid diseases and compliance with PAP therapy may be considered for ambulatory surgery.控制并存疾病、遵守PAP治疗的OSA患者，可以考虑门诊手术。 Patients are advised to apply their PAP devices when sleeping even in daytime for several days postoperatively. 如果患者术后出现白天睡眠，建议术后数天应用PAP治疗。 Diagnosed or suspected OSA patients without significant comorbidities, recurrent PACU respiratory events or need for high dose oral opioids may be considered for discharge home after minor surgery at the discretion of the attending physician. Emphasis was placed on advanced planning of the perioperative anesthetic and analgesic options, and timely education of patients and caregivers regarding their post-discharge care.确诊或疑似OSA患者，无显著合并症、复发性PACU呼吸事件或需要大剂量的口服阿片类药物的小手术，在主治医生的判断后，可考虑出院回家。重点应放在对围术期麻醉和镇痛选择好的计划，并就其出院后的护理及时教育患者和照顾者。