Z形腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征的疗效及影响因素

Effectiveness and related factors of Z-palatopharyngoplasty for treating obstructive sleep apnea hypopnea syndrome

目的探讨Z形腭咽成形术（Z-palatopharyngoplasty，ZPPP）治疗阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）的疗效及其影响因素。方法34例OSAHS患者扁桃体大小为1～3度，后气道间隙（posterior airway space，PAS）≥11mm，Friedman分型为Ⅱ、Ⅲ型，行ZPPP。术后6～12个月复查，对手术成功及失败患者的术前可能影响相关参数进行统计学分析。结果按杭州会议标准，治愈12例，显效10例，有效2例，无效10例，治愈率35．3％，累积显效率64．7％，累积有效率70．6％。将治愈与显效病例计为成功，其余以失败计，成功与失败患者两组间最低血氧饱和度（lowest oxygen saturation，LSaO2）、血氧饱和度低于0．90的时间占总睡眠时间的百分比（percentage of time with oxyhemoglobin saturation below 0．9，CT90）、下颌骨平面角、下颌体长度、舌位及Friedman分型差异有统计学意义。LSaO2、CT90、下颌骨平面角及下颌体长度等判断手术成功的最佳临界点分别是0．72、22．8％、29．4。及69．4am。Logistic回归分析显示Friedman分型和下颌骨平面角进入方程，设Friedman分型为X1，下颌骨平面角为炮，则Y=In[P／（1-P）]=-122．85＋31．57X1＋1．01X2。结论ZPPP应用于PAS≥11mm的FriedmanⅡ、Ⅲ型OSAHS患者取得较好的疗效。影响ZPPP手术疗效的因素包括LSaO2、CT90、下颌骨平面角、下颌体长度、舌位及Friedman分型，其中最主要因素是Friedman分型和下颌骨平面角。

Objective To investigate the efficacy and related factors of Z-palatopharyngoplasty for treating severe obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Thirty four OSAHS patients with graded 1-3 tonsil , posterior airway space（PAS） ≥11 mm , Friedman Ⅱ and Ⅲ oropharyngeal airway were included in this study, all cases had Z-palatopharyngoplasty. The follow up was at least 6 months postoperatively. Measurement parameters of responders and nonresponders were analyzed. Results According to related criterion of China, cure rate was 35.3%, accumulative total excellence rate 64. 7% and accumulative valid rate 70. 6%. The cured and excellence patients were considered as responders, the other as nonresponders. The lowest oxygen saturation（ LSaO2 ）, percentage of time with oxyhemoglobin saturation below 0. 90 （CT90）, mandibular plane angle （MPA）, mandibular body length, position of tongue and Friedman clinical stage are statistically significant between responder and nonresponder. The best cut points of LSaO2 , CT90 and MPA were 0. 72, 22. 80% and 29.40°respectively. The logistic regression showed that Friedman stage and MPA entered into equation, which was Y = In[ P/（ 1 - P） ] = - 122. 85 ＋ 31.57X1 ＋ 1.01X2, if setting X1 as Friedman stage, and X2 as MPA. Conclusions Z-palatopharyngoplasty is effective surgical approach for OSAHS patients with posterior airway space （ PAS ） ≥ 11 mm. The affective factors of Z-palatopharyngoplasty included LSaO2, CT90, MPA, mandibular body length, position of tongue and Friedman clinical stage. Among them, the mandibular plane angle and Friedman clinical stage were predominant factors.