正压通气治疗对改良悬雍垂腭咽成形术后疗效的影响

The effect of CPAP treatment in short time on severe OSAHS patients with revised Uvulopalatoph aryngoplasty

目的研究重度睡眠呼吸暂停低通气综合征(obstructiVe sleep apnea hypopnea syndrome,OSAHS)患者行改良悬雍垂腭咽成形术(H-uvulopalato phargngoplasty,H-UPPP)术后短期应用持续正压通气(continuous positive airwayy pressure,CPAP)治疗对疗效的影响。方法38例重度OSAHS患者分为两组,治疗组18例于手术后一周开始配戴CPAP治疗,平均应用34.3天。20例单纯行H-UPPP手术患者为对照组。两组患者于术后6个月行多导睡眠监测复查,并与术前进行比较。结果治疗组及对照组术后6个月与术前PSG监测相比,AHI及夜间最低血氧饱和度明显改善(P＜0.001)；治疗组术后6个月与对照组术后6个月相比,夜间最低血氧饱和度明显升高(P＜0.001),AHI之间的差异无显著性意义(P＞0.05)；睡眠结构中,治疗组的浅睡眠期和慢动眼睡眠期改变较对照组明显(P＜0.05),而深睡眠期、觉醒指数及睡眠效率的改变无显著性意义(P＞0.05)。结论改良UPPP术后行CPAP治疗可改善患者夜间低血氧的情况,使慢动眼睡眠期延长,减少浅睡眠期,对提高手术疗效有辅助作用。

OBJECTIVE To investigate the effects of continuous positive airway pressure （CPAP） on patients with severe obstructive sleep apnea hypopnea syndrome （OSAHS） who underwent the revised uvulopalatopharyngoplasty （UPPP）. METHODS 18 cases of severe OSAHS patients （therapy group） were selected for CPAP treatment in the 2nd week of postoperation. The average time of CPAP treatment was 34.3 days. The other 20 cases （control group） only underwent operation. All patients were monitored with PSG before operation and in the 6 months postoperatively. RESULTS Compared with the result of pre-operative PSG, apnea hypopnea index （AHI） and Lowest SaO2 （LSaO2） was improved （P 〈0.001） in two groups. Compared with control group, LSaO2 of the therapy group in the sixth month postoperatively was improved （P〈0.001）, but the decreasing of AHI was not significant （P〉0.05）. Contrast to the control group, the length of stage 1 and 2 decreased and that of REM increased. （P〈0.05）. CONCLUSION For severe OSAHS patients who underwent uvulopalatopharyngo plasty, CPAP treatment for one month postoperatively could improve the hypoxia of patients, and prolong REM stage, shorten the stage 1 and 2 sleep. CPAP treatment in short time would be helpful for the severe OSAHS patients with revised UPPP.