阻塞性睡眠呼吸暂停的术前查和查后干预措施的临床有效性:系统性审查和元分析
Rushil Parikh1, Linor Berezin2, Aparna Saripella2
1University of Ottawa School of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Journal of clinical anesthesia
|December 11, 2025
概括
在手术患者中进行阻塞性睡眠呼吸暂停 (OSA) 的术前查,可以确定那些面临并发症增加的高风险患者 (HR-OSA). 有针对性的干预措施可以减少这些不良的术后结果,尽管证据是初步的.
科学领域:
- 麻醉学和外科手术期间的医学.
- 睡眠医学 睡眠医学
- 手术结果研究研究.
背景情况:
- 阻塞性睡眠呼吸暂停 (OSA) 越来越多地被认为是手术患者的重大并发症.
- 被确定为OSA (HR-OSA) 高风险的患者与术后不良事件的增加有关.
- 术前OSA查的临床效用和干预措施的影响需要进一步评估.
研究的目的:
- 评估手术前查阻塞性睡眠呼吸暂停 (OSA) 的临床实用性.
- 确定针对性干预对降低高风险OSA (HR-OSA) 手术患者术后不良结果的影响.
主要方法:
- 对OSA查工具和手术环境中的干预措施的研究进行系统审查和元分析.
- 包括54项研究,包括324,935名患者.
- 主要结局:术后呼吸/心脏事件,妄想,停留时间 (LOS),ICU入院,再入院,死亡率.
主要成果:
- 与低风险OSA (LR-OSA) 患者相比,HR-OSA患者的呼吸道和心脏并发症几率明显更高,住院LOS更长.
- 在HR-OSA患者中,没有观察到痴呆症,ICU入院或30天再入院的显著增加.
- 针对HR-OSA患者的向干预 (例如,安全协议,教育) 与没有干预的患者相比,不良结果没有显著差异.
结论:
- 高风险阻塞性睡眠呼吸暂停 (HR-OSA) 被证实是术后不良事件的危险因素.
- 手术前的OSA查和有针对性的术后干预措施显示出减少不良结果的潜力.
- 目前关于干预疗效的证据受到异质性和数据质量的限制,需要进一步的探索性研究.
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