中枢性呼吸暂停与麻醉：病例回顾

作者：米勒之声

摘要译文

原发性中枢性睡眠呼吸暂停和麻醉：

一个回顾性病例系列

目的：

原发性（特发性）中枢性睡眠呼吸暂停（PCSA）是一种罕见的中枢性睡眠相关呼吸障碍，其特征是化学感受器对二氧化碳分压的敏感性增加，表现为过度换气，随后在非快动眼睡眠中出现呼吸暂停computer browser 。本回顾性研究的目的是描述PCSA患者的术后病程，以及需要麻醉管理的手术。

方法：

2010年1月1日至2016年6月1日期间，在我院确诊为PCSA并需要麻醉手术的患者，对其健康记录进行全面审查，重点是识别呼吸道并发症computer browser 。

结果：

10名患者（9名男性，1名女性）接受了47项需要麻醉管理的手术：20例（43%）在全麻下，25例（53%）在麻醉监护下，2例（4%）在区域麻醉下computer browser 。

手术因一名患者的二度心脏传导阻滞和另两名患者的肺炎而变得复杂（一名患者接受了Ivor Lewis食管切除术，另一名患者进行支气管镜检查以评估肺部浸润的恶化情况）computer browser 。

三名患者在麻醉恢复期间出现低氧血症（血氧饱和度<90%，持续三分钟）computer browser 。

一种可能是由于PCSA，一名73岁男性酒精性肝硬化患者，在矫形外科手术后出现中度镇静和低氧血症；他的氧合状况通过自适应伺服呼吸机气道正压装置和辅助供氧得到改善computer browser 。他的潜在疾病或镇静水平可能导致低氧血症。

其他患者在支气管镜检查后出现低氧血症computer browser 。

其他病例均未出现术后呼吸衰竭computer browser 。

结论：

术后无与PCSA相关的主要不良结局computer browser 。然而，在麻醉恢复期间继续家用气道正压通气治疗对一名肝硬化患者和术后低氧血症患者是有用的。

原文摘要

Primary central sleep apnea and anesthesia: a retrospective case series

Purpose:

Primary (idiopathic) central sleep apnea (PCSA) is a rare central sleep-related breathing disorder characterized by increased chemoreceptor sensitivity to partial pressure of carbon dioxide, which manifests as hyperventilation followed by apnea during non-rapid eye movement sleep. The purpose of this retrospective study was to describe the postoperative course of patients who had PCSA and underwent procedures requiring anesthetic management.

Methods:

Patients who received a diagnosis of PCSA at our institution and required procedural anesthesia between 1 January 2010 and 1 June 2016 underwent a comprehensive review of their health records with a focus on identifying respiratory complications.

Results:

Ten patients (nine males, one female) underwent 47 procedures requiring anesthetic management: 20 (43%) under general anesthesia, 25 (53%) with monitored anesthetic care, and two (4%) with regional anesthesia. Procedures were complicated by second-degree heart block in one patient and pneumonia in another two (one had Ivor-Lewis esophagectomy and the other bronchoscopy to evaluate worsening lung infiltration). Hypoxemia (oxyhemoglobin saturation < 90% for three minutes) developed in three patients during anesthesia recovery. One was possibly due to PCSA-a 73-yr-old male with alcoholic cirrhosis who was moderately sedated and hypoxemic after orthopedic surgery; his oxygenation improved with an adaptive servoventilator positive airway pressure device and supplemental oxygen. His underlying medical condition or level of sedation may have contributed to hypoxemia. The other patients became hypoxemic after bronchoscopy. No other cases were complicated by postoperative respiratory compromise.

Conclusions:

No major adverse outcomes were related to PCSA postoperatively. Nevertheless, continuation of home positive airway pressure therapy during anesthesia recovery was useful in one patient who had cirrhosis and postoperative hypoxemia.

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编辑：Michel.米萱

校对：Mijohn.米江

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