【罂粟摘要】气道正压通气可有效减少阻塞性睡眠呼吸暂停患者的术后不良后果:一项系统性回顾和Meta分析

气道正压通气可有效减少阻塞性睡眠呼吸暂停患者的术后不良后果:一项系统性回顾和Meta分析

贵州医科大学      麻醉与心脏电生理课题组

翻译：潘志军     编辑：宋雨婷     审校：曹莹

1

重要性及目的

阻塞性睡眠呼吸暂停(OSA)在外科患者中较为常见，并与围术期不良事件的发生风险增加有关。本研究旨在探讨气道正压通气(PAP)治疗降低OSA患者术后并发症发生风险的有效性。

2

试验设计

本研究为一项系统性评价和Meta分析，从Medline和其他数据库进行系统地检索，截止时间为2021年10月17日。搜索词包括:“气道正压”、“手术”、“术后”和“阻塞性睡眠呼吸暂停”。纳入标准为:(1)接受手术的成年OSA患者；(2)术前和/或术后使用PAP的患者；(3)至少有一项术后结果报告；(4)对照组（OSA手术患者，术前和/或术后未接受PAP治疗)；(5)英文文章。

3

受试对象及干预措施

27项研究包括30514名接受非心脏手术的OSA患者和837名接受心脏手术的OSA患者。干预措施：气道正压通气治疗

3

结果

在接受非心脏手术的OSA患者中，PAP治疗与术后呼吸系统并发症降低(2.3%比3.6%；RR: 0.72, 95% CI: 0.51-1.00，渐近P = 0.05)和计划外入ICU(0.12%比 4.1%；RR: 0.44, 95% CI: 0.19-0.99，渐进P = 0.05)相关。两组间在全因并发症（11.6%比14.4%；RR：0.89，95% CI：0.74-1.06，P =0.18）、术后心脏和神经系统并发症、住院时间和院内死亡率方面未发现明显差异。在接受心脏手术的OSA患者中，PAP治疗与减少术后心脏并发症(33.7%比50%；RR: 0.63, 95% CI: 0.51-0.77, P < 0.0001)、术后心房颤动(40.1%比66.7%；RR: 0.59, 95% CI 0.45-0.77, P < 0.0001)相关。

3

结论

在接受非心脏手术的OSA患者中，PAP治疗与术后呼吸并发症风险降低28%和计划外入ICU风险降低56%相关。在接受心脏手术的OSA患者中，PAP治疗可将术后心脏并发症和房颤的风险分别降低37%和41%。

原始文献来源：

Linor Berezin, Mahesh Nagappa,Khashayar Poorzargar,et al.The effectiveness of positive airway pressure therapy in reducing postoperative adverse outcomes in surgical patients with obstructive sleep apnea: A systematic review and meta-analysis [J]. (J Clin Anesth. 2023 Feb;84:110993).

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英文原文

The effectiveness of positive airway pressure therapy in reducing postoperative adverse outcomes in surgical patients with obstructive sleep apnea: A systematic review and meta-analysis        

Importance: Obstructive sleep apnea (OSA) is prevalent in surgical patients and is associated with an increased risk of adverse perioperative events.

Study objective: To determine the effectiveness of positive airway pressure (PAP) therapy in reducing the risk of postoperative complications in patients with OSA undergoing surgery.

Design: Systematic review and meta-analysis searching Medline and other databases from inception to October 17, 2021. The search terms included: “positive airway pressure,”“surgery,”“post-operative,” and “obstructive sleep apnea.” The inclusion criteria were: 1) adult patients with OSA undergoing surgery; (2) patients using preoperative and/or postoperative PAP; (3) at least one postoperative outcome reported; (4) control group (patients with OSA undergoing surgery without preoperative and/or postoperative PAP therapy); and (5) English language articles.

Patients: Twenty-seven studies included 30,514 OSA patients undergoing non-cardiac surgery and 837 OSA patients undergoing cardiac surgery.

Intervention: PAP therapy.

Main results: In patients with OSA undergoing non-cardiac surgery, PAP therapy was associated with a decreased risk of postoperative respiratory complications (2.3% vs 3.6%; RR: 0.72, 95% CI: 0.51–1.00, asymptotic P=0.05) and unplanned ICU admission (0.12% vs 4.1%; RR: 0.44, 95% CI: 0.19–0.99, asymptotic P=0.05). No significant differences were found for all-cause complications (11.6% vs 14.4%; RR: 0.89, 95% CI: 0.74–1.06, P=0.18), postoperative cardiac and neurological complications, in-hospital length of stay, and in-hospital mortality between the two groups. In patients with OSA undergoing cardiac surgery, PAP therapy was associated with decreased postoperative cardiac complications (33.7% vs 50%; RR: 0.63, 95% CI: 0.51–0.77, P<0.0001), and postoperative atrial fibrillation (40.1% vs 66.7%; RR: 0.59, 95% CI 0.45–0.77, P<0.0001).

Conclusion: In patients with OSA undergoing non-cardiac surgery, PAP therapy was associated with a 28% reduction in the risk of postoperative respiratory complications and 56% reduction in unplanned ICU admission.