软腭射频消融术对阻塞性睡眠呼吸暂停低通气综合征的疗效评价

Effect of radiofrequency volumetric reduction of palate on patients with obstructive sleep apnea hypopnea syndrome

目的观察低温射频消融术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的疗效和副作用。方法51例OSAHS患者，男43例，女8例，平均年龄48．45±11．29岁，平均体重指数25．44±2．80kg／m^2，以呼吸暂停低通气指数（AHI）20次／小时为标准，分轻度组和中重度组。使用美国安泰Coblator手术系统，Rf55射频刀头进行操作，术前及术后3个月复查PSG，同时进行嗜睡和鼾声症状记分．分别比较手术前后两组患者PSG相关参数、症状记分及患者对手术疗效的主观评价。结果①完成PSG复查的共25例，轻度10例，中重度15例，轻度组手术前后PSG睡眠结构及低氧的各项指标均无明显改变，而夜间AHI术后反而加重，中重度组手术前后PSG各项观察指标包括睡眠结构、呼吸紊乱和低氧情况均无显著改善，而低氧状况有加重趋势。②手术前后两组患者嗜睡症状记分无显著改变，鼾声记分轻度组手术后有明显改善（5．30±0．977253．40±1．85，P〈0．05），中重度组变化无显著性差异（5．68±0．75vs5．24±1．33，P〉0．05）。③患者对手术疗效的主观评价，轻度组20例中有13例（65％）有效，其中5例（25％）有明显改善，而中重度组25例中仅6例（24％）有效，无显著改善者。④术后疼痛轻，持续3～7天；仅1例（1．96％）有出血；无感染等并发症。结论低温射频消融术是一种操作简便、相对安全的手术方法，适合单纯鼾症和轻度OSAHS患者，不适宜中重度患者。

Objective To evaluate the efficacy and safety of radiofrequency volumetric reduction of soft palate for the patients with obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods 51 cases of OSAHS,male 43,female 8,mean age 48.45±11.29 years,mean BMI 25.44±2.80kg/m^2 ,the patients were divided into two groups：mild group,apnea hypopnea index（AHI）〈20/h and moderate severe group, AHI〉20/h according to the polysomnography. Every patients be treated by radiofrequency volumetric reduction of soft palate with Coblator surgery system. The symptoms score of snoring, sleepiness and polysomnograpy of two groups patients were compared before and three months after operation, the patient＇s subjective evaluation for therapy also be recorded. Results There are no improvement of the objective parameters （the sleep structure,hypoxemia and AHI） in two groups cases after therapy, the parameter of AHI in mild group and the oxygen desaturation in moderate severe group were became worse. The snoring score in mild group was improvement significantly after operation（5.30±0.97 vs 3.40±1.85, P 〈0.05）,the sleepiness score in two groups and the snoring score in moderate severe group were no improvement（5.68±0.75 vs 5.24± 1.33, P 〉0.05）. The efficiency of patient＇s subjective evaluation for therapy was 65% （mild group） and 24% （ moderate severe） respectively. Bleeding was seen in 1 patient （1.96%） ,no infections in all of the patients. Conclusions Radiofrequency volumetric reduction of palate is a effective safely method of reduce snoring for mild OSAHS,not for the moderate severe patients.