上气道多部位同期手术治疗阻塞性睡眠呼吸暂停低通气综合征的效果探讨

Therapeutic Effects of Multiplanar Operation Simultaneously in Upper Respiratory System for the Obstructive Sleep Apnea Hypopnea Syndrome

摘要: 目的：观察存在上气道结构性狭窄的阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)患者同期行多部位手术的治疗效果，探讨提高OSAHS治疗效果、提高CPAP呼吸机治疗顺应性及依从性的方法。方法：对30例中重度OSAHS患者采用鼻腔扩容术、悬雍垂咽成形术(uvulopalatopharyngoplasty, UPPP)、鼻咽部腺样体切除或舌根淋巴组织切除术，围手术期使用经鼻持续正压通气治疗。结果：30例患者手术完成顺利，围手术期无严重并发症发生。比较手术前、术后6个月睡眠呼吸紊乱指数(AHI)、CT90% (血氧饱和度低于90%的时间占总睡眠时间的百分比)，差异均有统计学意义(P < 0.05)；ESS嗜睡评分、主观症状VAS评分明显改善，差异有统计学意义(P < 0.05)。结论：多部位联合手术是一种治疗重度OSAHS有效的方法，术后病人睡眠呼吸监测的各项指标、疾病相关症状以及患者的生活质量明显改善，并提高了后期呼吸机治疗的顺应性及依从性，经治患者均获得满意疗效。

Abstract: Objective: To investigate the effect of multiplanar operation at the same term for the obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: 30 cases with OSAHS received nasal recon-struction, uvulopalatopharyngoplasty (UPPP), adenoidectomy or Tongue root lymphoidectomy. Before the operation, all severe cases underwent continuous positive airway pressure (CPAP) therapy. Results: In 30 cases, all the operations were performed successfully. No death or severe complications occurred during the operation and follow-up. According to polysomnography (PSG), the effectiveness was 97% 6 months later. 6 months after the operation, the changes of AHI and CT90% were significant (P < 0.05) compared with those preoperative. Epworth sleepiness scores and Visual analogue scores (VAS) for subjective symptoms were decreased after surgery (P < 0.05). The shape of airway was improved significantly. Conclusion: The multiplanar operation at the same term is safe and effective for OSAHS. The shape of upper airway tends to be normal. The living quality of the patients was significantly improved after the operations. CPAP before the operation can effectively prevent postoperative severe complications.