射频组织减容辅助上气道手术治疗阻塞性睡眠呼吸暂停低通气综合征的研究

Treatment of obstructive sleep apnea-hypopnea syndrome with radiofrequency volumetric tissue reduction collaborating upper-airway procedure

目的探讨射频组织减容(RFVTR)用于阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者上气道全方位手术治疗的疗效和手术前后生活质量的变化。方法根据术前定位诊断的结果,对86例OSAHS患者行多平面RFVTR治疗,治疗前和治疗后6个月行睡眠呼吸监测(PSG),比较呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、Epworth嗜睡评分(ESS)、打鼾等级评分(SSS)和Calgary生活质量指数(SAQLI),评价RFVTR治疗OSAHS的疗效。结果86例手术均顺利进行,对患者进行综合疗效评价:治愈率为34.9%,显效率为41.9%,有效率为18.6%,总有效率为95.3%。手术前后AHI分别为44.8±22.6和30.5±21.6,LSaO2分别为72.5±9.5和76.7±8.7,术后AHI和LSaO2均较术前明显改善(P<0.05)。Epworth嗜睡程度评分由术前15.3±4.4下降至术后11.6±4.1,SSS鼾声等级由术前的6.1±1.6下降至5.2±1.7;SAQLI总分从术前3.9±1.1提高到术后4.7±1.2,RFVTR治疗后白天嗜睡程度和鼾声评级以及患者生活质量均较术前明显改善(P<0.05)。结论RFVTR操作便捷、安全,患者痛苦小、恢复速度快且容易接受,是治疗OSAHS的有效方法,可明显改善OSAHS患者的生活质量。

Objective To investigate the efficacy and value of radiofrequency volumetric tissue reduction （RFVTR） in treatment of obstructive sleep apnea-hypopnea syndrome （OSAHS）. Method According to the preoperative diagnosis of obstructive level, 86 patients with OSAHS were treated by RFVTR. A all night polysomnography （PSG） examination was performed before and six months after operation for all the patients. Meanwhile the apnea hypopnea index （AHD, lowest arterial oxygen saturation （LSaO2） and the Epworth sleepiness scale （ESS）, Stanford sleepiness scale （SSS）, and the Calgary sleep apnea quality of life index （SAQLI） were assessed. The final efficacy was then evaluated. Results All the operative procedures were carried out nicely. The comprehensive efficacy in the 86 patients was then assessed. The outcomes were as follows： the recovery rate was 34. 9%, the excellent rate was 41.9%, and the effective rate was 18. 6%, making a total effective rate of 95. 3%. After RFVTR, the AHI was decreased from 44.8±22. 6 to 30. 5±21.6; the LSaO2 was increased from 72. 5±9. 5 to 76. 7±8. 7; the ESS was decreased from 15. 3±4. 4 to 11. 6±4. 1, the SSS was decreased from 6. 1±1. 6 to 5. 2±1.7 and the SAQLI increased from 3. 9±1. 1 to 4. 7±1.2. After the operation of RFVTR, the degree of lethargy in daytime, the level of snoring and the quality of life of patients were improved obviously （P〈0. 05）. All the improvement mentioned above was significant （P〈0.05）. Conclusion Being an effective treatment for OSAHS, RFVTR is a simple, safe, repeatable and acceptable surgical procedure, which may admirably improve the life quality of the OSAHS sufferers.