Analyzing the reasons for and prevention of serious complications after general anesthesia in children with obstructive sleep apnea
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摘要: 目的 探讨儿童阻塞性睡眠呼吸暂停(obstructive sleep apnea，OSA)全身麻醉手术后呼吸暂停发生的原因及预防措施，提高OSA全身麻醉手术的安全性。方法 回顾性分析2020年3月—2022年3月南方医科大学深圳医院发生的4例OSA患儿全身麻醉手术后呼吸心搏骤停事件的临床及随访资料。结果 4例OSA患儿全身麻醉术后出现不同程度的血氧饱和度下降、发绀、意识丧失，其中1例出现呼吸心搏骤停。经过吸氧、吸痰、加压通气、唤醒及心肺复苏等措施积极抢救，4例患儿均转危为安。术后随访2~6个月，患儿均无并发症发生。术后呼吸暂停发生的主要原因可能包括麻醉药物残留、OSA疾病的特性以及儿童群体的特殊性。结论 儿童OSA全身麻醉手术后需密切关注患儿生命体征，若出现呼吸抑制，应积极抢救，避免出现严重后果。Abstract: Objective To explore the causes and preventive measures of respiratory arrest following general anesthesia in children with obstructive sleep apnea (OSA), in order to enhance the safety of OSA surgeries under general anesthesia.Methods A retrospective analysis was conducted on the clinical and follow-up data of four pediatric cases that experienced respiratory arrest after general anesthesia for OSA at Shenzhen Hospital of Southern Medical University from March 2020 to March 2022.Results All four children exhibited varying degrees of decreased blood oxygen saturation, cyanosis, and loss of consciousness after OSA surgery under general anesthesia, with one case experiencing respiratory and cardiac arrest. Through emergency rescue measures such as oxygen supplementation, suctioning, positive pressure ventilation, awakening, and cardiopulmonary resuscitation, all four children were stabilized. Follow-up after 2 to 6 months showed no complications. The main reasons for the occurrence are analyzed as: residual anesthetic drugs, characteristics of the OSA disease, and the unique aspects of the pediatric population.Conclusion Children undergoing general anesthesia for OSA should be closely monitored for vital signs after surgery. If respiratory suppression occurs, active rescue measures should be taken to avoid serious consequences.
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Key words:
- obstructive sleep apnea /
- respiratory depression /
- cardiac arrest /
- anesthesia recovery
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表 1 4例OSA术后发生呼吸心跳意外事件的患儿基本信息及抢救情况
例序 性别 年龄 体重/kg 手术名称 呕吐误吸 气管痉挛 手术时长/min 复苏时长/min 复苏结束/min 表现 抢救措施 预后 1 男 3岁
12个月15.1 扁桃体伴腺样体切除术 无 无 23 20 5 呼之不应，口唇发绀，SpO2 72% 侧卧、吸痰、高流量吸氧 良好 2 女 3岁
7个月13.6 腺样体切除术 无 无 20 28 1 口唇发绀、面色苍白、呼之不应，SpO2 84% 侧卧、吸痰、高流量吸氧 良好 3 女 8岁
2个月19.3 扁桃体伴腺样体切除术 无 无 29 46 1 嗜睡，面唇发绀，心音偏低，SpO2 87% 侧卧、吸痰、吸氧无好转，球囊面罩通气 良好 4 男 3岁
7个月14.6 扁桃体伴腺样切除术+鼓膜置管术 无 无 32 27 9 颜面青紫、意识及自主呼吸丧失，SpO2 31%，颈动脉搏动不明显 持续胸外按压、吸痰、球囊面罩通气、补液 良好 
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