阻塞性睡眠呼吸暂停综合征悬雍垂腭咽成形术的临床观察

Longterm follow-up of patients with obstructive sleep apnea syndrome treated with uvulopalatopharyngoplasty

目的 探讨悬雍垂腭咽成形术 (uvulopalatopharyngoplasty,UPPP)对阻塞性睡眠呼吸暂停综合征 (obstructivesleepapneasyndrome ,OSAS)的远期疗效及对糖、脂代谢的影响。方法 对 32例OSAS患者 (中度 6例 ,重度 2 6例 )连续观察术前、术后 1个月、术后 3年时的呼吸紊乱指数 (respiratorydisturbanceindex ,RDI)、体块指数、血压、血糖、甘油三酯、胆固醇的变化。结果 以RDI下降 75 %为OSAS显效作标准 :手术后 1个月时显效率 37.5 % ,3年后降为 13.8% ;有效率术后 1个月为 87.5 % ,3年后为 5 5 .2 %。手术后 3年体块指数、血压、血糖、甘油三酯、胆固醇均较手术前显著下降 ,统计学处理P值均 <0 .0 5 ,差异有显著性意义。结论 UPPP能改善中、重度OSAS患者的低氧血症 ,降低血压、血糖、甘油三酯、胆固醇 ;远期疗效差于近期疗效。术后疗效可能与术前体块指数、RDI。

Objective To study the long term outcome of uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea syndrome (OSAS). Methods Long term follow up for 32 cases of patients with OSAS was conducted in 3 years after UPPP. The respiratory disturbance index (RDI), body mass index (BMI), blood pressure (BP), fasting blood glucose (FBG), triglyceride, cholesterol were followed. Results RDI was reduced markedly from 58.1±25.5 to 38.7±15.3 at 3 years after UPPP. The total effective rate was 87.5% after one month. 55.2% after 3 years. Their BMI, BP, FBG, triglyceride and cholesterol were also reduce significantly. Conclusion UPPP can improve the hypoxemia of patients with OSAS, reduced the BP, FBG, BMI, improve the lipid metabolism. Long term outcomes of UPPP were possibly related to the preoperative BMI, RDI, the skeletal structure of the upper airway and postoperative BMI change. After UPPP, long term follow up is recommended because some initially successfully treated patients with OSAS will relapse in the later follow up.