减重代谢手术治疗肥胖合并阻塞性睡眠呼吸暂停低通气综合征

杨珵璨 王兵

摘 要 阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome， OSAHS）是一种发病隐匿的慢性、潜在致死性疾病，也是病态肥胖症的最常见合并症之一。由于面颅软硬组织解剖结构异于西方人种，东亚人种的OSAHS患病率更高，且程度更严重。减重代谢手术对肥胖合并OSAHS的治疗作用已获公认，但现减重代谢外科医师对OSAHS的认知仍严重不足。对减重代谢外科患者进行OSAHS筛查是完全必要且可行的，多导睡眠监测是诊断OSAHS的金标准。本文就减重代谢手术的术前正压通气治疗，术中气道管理、麻醉注意事项、麻醉药物选择、患者体位选择和手术方式选择等问题作一阐述，而整个诊治过程的标准化无疑可使更多的患者受益。

关键词 减重代谢手术 阻塞性睡眠呼吸暂停低通气综合征 肥胖

中图分类号： R656.61； R563.8 文献标志码：A 文章编号：1006-1533（2021）11-0003-03

Metabolic and bariatric surgery for obesity combined with obstructive sleep apnea hypopnea syndrome

YANG Chengcan， WANG Bing*

（Department of General Surgery， Shanghai Ninth Peoples Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200011， China）

ABSTRACT Obstructive sleep apnea hypopnea syndrome （OSAHS） is a chronic and potentially fatal disease with insidious onset and one of the most common complications of morbid obesity. The prevalence of OSAHS in East Asian races is higher and the severity is more serious than Western races because of the difference in the anatomical structure. The effect of metabolic and bariatric surgery （MBS） on obesity combined with OSAHS has been recognized， but surgeons are still seriously lacking in understanding of OSAHS. OSAHS screening is completely necessary and feasible for MBS patients， and polysomnography is the gold standard for diagnosis of OSAHS. This article discusses the preoperative positive pressure ventilation treatment of MBS， the intraoperative airway management， the precautions of anesthesia and the selection of anesthetic drugs as well as the selection of patient position and surgical methods. The standardization of the entire diagnosis and treatment process will undoubtedly benefit more patients.

KEy WORDS metabolic and bariatric surgery； obstructive sleep apnea hypopnea syndrome； obesity

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome， OSAHS）是一种睡眠呼吸障碍疾病，常由上呼吸道阻塞引起，造成睡眠期间重复性的呼吸中止或通气量降低，且多伴有血氧饱和度下降，进而导致产生一系列的病理生理学改变。OSAHS是一种发病隐匿的慢性、潜在致死性疾病，也是病态肥胖症的最常见合并症之一。OSAHS的发病率随体质量增加而升高，中国成年人的OSAHS患病率估计值高达12%[1]。有研究表明，体质量指数每增高1%，OSAHS的发病概率就升高1.14%[2]。在减重代谢外科诊治的患者中，OSAHS患病率高达35.0% ～ 93.6%[3]；特别是当OSAHS重叠肥胖低通气综合征（obesity hypoventilation syndrome， OHS）时，患者的围术期并发症发生率和死亡率均将显著增高[4]。……