轻中度阻塞性睡眠呼吸暂停低通气综合征疗效比较

Curative effect of uvulopalatopharyngoplasty and radiofrequency ablation on mild to moderate obstructive sleep apnea hypopnea syndrome

目的比较悬雍垂腭咽成形术(uvulopalato-pharyngoplasty,UPPP)和等离子低温射频消融(radiofrequencyablation,RFA)治疗轻中度阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)的疗效。方法选择79例轻中度OSAHS患者(阻塞平面位于腭和扁桃体水平),随机分成两组分别接受UPPP和RFA治疗,比较术前和术后呼吸暂停低通气指数(apneahypopneaindex,AHI)、最低血氧饱和度(lowestsaturationofbloodoxygen,LSaO2)、鼾声评级及Epworth嗜睡程度评分,比较术后3天时和7天时疼痛、讲话及吞咽的影响评分,并比较两组患者之间的差异。结果UPPP组和RFA组有效率分别为74.3%和72.2%,疗效相近。两组患者术前和术后6个月多导睡眠描记(polysomnography,PSG)监测比较显示:治疗后LSaO2显著提高(P<0.05),AHI的减低非常显著(P<0.01),两组患者之间比较无明显差异;两组患者治疗8周后鼾声评级较治疗前降低非常显著(P<0.01),Epworth嗜睡程度评分亦较治疗前降低非常显著(P<0.01),两组患者之间比较无明显差异;术后3天时比较,RFA组比UPPP组疼痛和吞咽明显轻微(P<0.05),两组患者讲话无明显差异;术后7天时比较,RFA组比UPPP组疼痛明显轻微(P<0.05),两组患者讲话和吞咽无明显差异。结论RFA治疗轻中度OSAHS安全、创伤小、恢复快,疗效与UPPP相近。

OBJECTIVE To investigate the curative effect of uvulopalatopharyngoplasty （UPPP） and radiofrequency ablation（RFA）on mild to moderate obstructive sleep apnea hypopnea syndrome（OSAHS）. METHODS 79 cases of mild to moderate OSAHS whose obstruction site were soft palate and tonsil were divided randomly into two groups to accept UPPP and RFA respectively. Preoperative apnea hypopnea index（AHI）,lowest saturation of blood oxygen（LSaO2）snoring scale and Epworth sleepiness scale were comparaed with those postoperative to value the curative effect of UPPP and RFA. The feel of pain,speaking and swallow in the third day after operation were also comparaed with those in the seventh day after operation.The two groups were compared with each other. RESULTS The effective ratio of UPPP group and RFA group were 74.3 % and 72.2 % respectively. 6 months after operation,lowest saturation of blood oxygen（LSaO2） inproved significantl y（P〈0.05）,apnea hypopnea index（AHI）decreased much significantly（P〈0.01 ）,there were no difference between the two groups on AHI and LSaO2. 8 weeks after treatment, snoring scale and Epworth sleepiness scale both decreased much signiflcantly（P〈0.01）,there were no difference between the two groups on snoring scale and Epworth sleepiness scale. The pain and swallow of RFA group were milder than ones of UPPP group in the third day after operation（P〈0.05）,there was no difference between the two groups on speaking. The pain of RFA group were milder than that of UPPP group in the seventh day after operation（P〈0.05）, there was no difference between the two groups on speaking and swallow. CONCLUSION The curative effect of RFA is similar to that of UPPP.Since patients feel milder pain and recover quickly, RFA is a effective treatment.