鼻腔扩容术治疗轻中度阻塞性睡眠呼吸暂停低通气综合征的疗效分析

Curative effect analysis of nasal cavity expension surgery for treatment of obstructive sleep apnea hypopnea syndrome

目的探讨鼻腔扩容术在治疗存在鼻腔平面狭窄的轻中度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）中的临床疗效。方法 2010年1月~2013年1月住院治疗的有鼻阻塞症状、检查鼻腔平面存在狭窄的轻中度OSAHS患者36例,行鼻内镜下鼻腔扩容术。以Epworth嗜睡量表评估患者手术前后嗜睡程度,视觉模拟量表（VAS）评价鼻塞和鼾声症状的变化,观察鼻吸气相总阻力（TRNI）和鼻呼气相总阻力（TRNE）改善情况,并分析呼吸暂停低通气指数（AHI）和最低血氧饱和度（LSaO_2）的变化。结果 36例患者中总有效22例（61.11%）,其中显效17例（占总例数的47.22%）,治愈5例（占总例数13.89%）,无效14例（占38.89%）。手术后患者嗜睡程度、右鼻塞VAS、左鼻塞VAS、TRNI、TRNE和AHI显著改善,差异均有统计学意义（t值分别为5.10、11.48、8.24、18.21、17.94和6.98,P值均〈0.05）;LSaO_2、鼾声手术前后比较,差异无统计学意义（t值分别为0.51和0.53,P值均〉0.05）。结论鼻腔扩容术可以有效改善存在鼻腔平面狭窄的OSAHS患者的鼻塞症状、鼻通气功能和嗜睡程度。

Objective To discuss the curative effect of nasal cavity expention surgery in the treatment of mild/moderate obstructive sleep apnea hypopnea syndrome（OSAHS） due to nasal area narrow. Methods Endoscopic nasal cavity expansion surgery was performed in 36 patients with mild/moderate OSAHS and nasal obstruction from January 2010 to January 2013. The Epworth sleepiness scale was used to assess somnolence degree before and after operation. Visual analogue scale（VAS） was used to evaluate nasal obstruction and snoring symptoms. Total resistance of nasal inspiratory phase（TRNI）, total resistance of nasal expiratory phase（TRNE）, apnea hypopnea index（AHI）, and the lowest oxygen saturation（LSaO_2） was also analyzed. Results Twenty-two cases were effective（22/36, 61.11%）, of which 17 cases markedly improved（17/36, 47.22%）, 5 cases cured（5/36, 13.89%）, and 14 cases invalided（14/36, 38.89%）. Somnolence, VAS（right/left nasal obstruction）, TRNI, TRNE, and AHI were statistically significant improved after operation（t-value were 5.101, 11.479, 8.239, 18.205, 17.938 and 6.982, respectively; P〈0.05）; however, LSaO_2 and snoring had no statistical significance before and after operation（t-value were 0.511 and 0.529, respectively; P〉0.05）. Conclusion Nasal obstruction symptom, nasal ventilatory function and somnolence degree in OSAHS patients with nasal area narrow can be improved effectively after nasal cavity expansion surgery.