阻塞性睡眠呼吸暂停低通气综合征患者双侧鼻腔扩容术前后鼻腔通气程度主客观的变化

Subjective and Objective Evaluations for the Efficacy of Nasal Cavity Expansion Surgery on Nasal Airway in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

目的:探讨双侧鼻腔扩容术对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者鼻腔通气程度主客观的影响。方法:对75例成人OSAHS患者采用双侧对称性鼻腔扩容术,并分为A组30例(鼻腔扩容术)和B组45例行鼻腔扩容术+改良悬雍垂腭咽成形术(H-UPPP),同时选择15例只行H-UPPP作为对照组(C组),术前、术后3个月及12个月分别进行鼻塞视觉模拟量表(VAS)评分和使用鼻阻力计对总鼻阻力(TNR)进行检测,同时术前和术后12个月分别行睡眠呼吸监测(PSG)和进行Epworth嗜睡量表(ESS)评分。结果:75例OSAHS患者术后3个月和12个月TNR分别与术前相比明显降低并恢复至正常值,有显著性意义(P<0.05);75例患者主观鼻腔通气程度VAS评分也由术前的6.69±1.53下降为术后3个月时的3.38±1.37、术后12个月时的3.42±1.25(P<0.05)。与术前比较,术后12个月A、B两组呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)和ESS评分均显著改善(P<0.05),C组AHI和LSaO2也显著改善(P<0.05),但ESS评分无明显变化。B组术后12个月的AHI、LSaO2及ESS评分改变较C组明显(P<0.05)。结论:双侧鼻腔扩容术能在一定程度上改善OSAHS患者主观鼻腔通气症状,同时也可改善鼻腔通畅状况的客观指标,可能有利于OSAHS患者的治疗。

Objective：To investigate the subjective and objective effect of bilateral nasal cavity expansion of obstructive sleep apnea hypoxia syndrome（OSAHS）in patients with nasal patency.Methods：75cases of adult patients with OSAHS were recruited and divided into group A（only for nasal cavity expansion）of 30 cases and 45 cases in group B（nasal cavity expansion of＋H-UPPP）,at the same time,15 patients received H-UPPP only as control group（group C）.The subjective nasal patency was assessed by nasal visual analogue scale（VAS）,and the objective measurements were performed by rhinomanometry for total nasal airway resistance at 75 Pa and 150 Pa pressure points before and 3months and 12 months after nasal cavity expansion surgery,while preopera-tive and 12 months postoperative PSG and Epworth sleepiness scale（ESS）were also performed.Results：After surgery,all the 75 cases had improved in total nasal airway resistance,VAS,apnea and hypopnea index（AHI）and LSaO2.Except for group C,most cases showed significant changes in ESS scores.Conclusion：Bilateral nasal cavity expansion surgery not only improves subjective sensation of nasal obstruction to a certain extent,but also improves objective measure of nasal patency,which may have beneficial effects for the patients with OSAHS.