鼻通气手术治疗阻塞性睡眠呼吸暂停低通气综合征的疗效

Nasal ventilation surgery for patients with obstructive sleep apnea hypopnea syndrome

目的:探讨鼻通气手术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法:71例OSAHS患者经多道睡眠图(PSG)监测确诊,同时应用纤维鼻咽喉镜及电视摄像系统检查确定存在鼻阻塞性病变并行鼻通气手术,分析术后Epworth嗜睡(ESS)评分及PSG主要监测指标的变化。结果:ESS评分由术前的14.8±5.2下降为9.7±4.6(t=6.19,P=0.00),差异有统计学意义。术后PSG监测显示,显效8例,有效29例,无效34例。睡眠结构分析表明,鼻通气手术后觉醒时间明显减少,浅睡眠〔非快速眼动睡眠(NREM)1期〕明显减少,中度睡眠(NREM 2期)明显增多,快速眼动睡眠(REM)睡眠明显增多(P<0.01);深度睡眠(NREM 3+4期)差异无统计学意义(P>0.05)。PSG主要指标呼吸暂停指数(AI)、低通气指数(HI)、最低血氧饱和度(LSaO2)、微觉醒指数和鼾声指数术后均明显好转,差异有统计学意义(P<0.01),而呼吸暂停低通气指数(AHI)和体重指数(BMI)手术前后差异无统计学意义(P>0.05)。结论:鼻通气手术对存在鼻阻塞性病变的OSAHS患者有一定的治疗作用,应纳入整个OSAHS治疗计划中;OSAHS患者行鼻部手术后再行PSG监测对选择腭咽部术式有指导意义。

Objective： To evaluate the effect of operation for improving ventilation of nose in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods： The Epworth sleepiness scale（ESS） and polysomnography（PSG） were assessed pre- and postoperatively in 71 OSAHS patients with nasal anatomical stricture by using a flexible fiberoptie endoscope and a video recorder equipment, and septal surgery with or without inferior turbinectomy was performed. Results： ESS decreased from 14.8 ± 5.2 to 9.7 ± 4.6 after surgery （ t = 6.19, P = 0.00）. According to the results of postoperative polysomnography, 8 cases in evident efficiency, 29 efficiency and 34 nonefficiency. Improvements in sleep architecture were observed after nasal surgery, and there was a significant reduction in awakening and non-rapid eye movement （NREM） sleep 1 phase, but a significantly increase in NREM sleep 1 phase and rapid eye movement （REM）sleep phase（ P 〈 0.01 ）. There were no significant changes in NREM 3 ＋ 4 phase（ P 〉 0.05）. Nasal surgery resulted in a significant decrease in apnea index （AI）, hypopnea index （HI）, microarousal index and snoring index, but a significant increase in lowest oxygen saturation levels （ P 〈 0. O1 ）. The number of apnea and hypopnea episodes per hour and the body mass index （BMI） did not change significantly （ P 〉0.05）. Conclusions ： Nasal surgery has a limited efficacy in adult patients with OSAHS. Correction of the obstructed nasal airway should certainly be included in the overall treatment for OSAHS. The secondary surgery （such as uvulopalatoplasty） may be considered after a thorough evaluation by postoperative PSG .