上气道测压阻塞定位在阻塞性睡眠呼吸暂停低通气综合征外科治疗中的应用

Outcomes of upper airway reconstructive surgery for moderate to severe obstructive sleep apnea syndrome based on upper airway pressure measurements

目的 通过分析上气道测压阻塞定位指导的中、重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）外科随诊疗效,了解上气道测压阻塞定位的临床应用价值.方法 对51例中、重度OSAHS患者应用睡眠呼吸监测阻塞定位仪（ApneaGraph,AG）进行整夜睡眠呼吸监测和同步上气道压力测定.根据阻塞层面,分成2组.腭后区阻塞组：以上部阻塞为主,行腭后区手术;舌后区阻塞组：最低阻塞层面以下部为主,结合纤维喉镜观察阻塞结构,行腭部及不同的舌后区联合手术.以上两组患者,有鼻塞症状的,均同期行鼻部手术.术后6个月再次应用AG随访,评估手术疗效.结果 51例患者中,中度5例,重度46例,其中4例为UPPP失败再手术者.术后随访时间6～24个月,中位数为9个月.Epworth嗜睡评分（ESS）由术前（17.6±4.7）分（（-x）±s,下同）降至（4.3±4.3）分（t=15.195,P〈0.001）,呼吸暂停低通气指数（AHI）由（52.4±17.5）次/h降至（16.3±18.2）次/h（t=10.873,P〈0.001）,最低血氧饱和度（LSaO2）由0.706±0.099提高至0.823±0.092（t=-8.396,P〈0.001）,差异均有统计学意义.总手术成功率（术后AHI〈20次/h,且降幅≥50%）为76.5%,其中治愈14例,显效25例,有效6例,无效6例.腭后区阻塞组27例,手术成功率81.5%;舌后区阻塞组24例,成功率75.0%.结论 上气道压力测定法能较准确地判断上气道阻塞平面,与传统检查相结合,制定个体化手术方案,可能提高中重度OSAHS的手术疗效.

Objective To assess the effect of upper airway reconstructive surgery for moderate to severe obstructive sleep apnea-hypopnea syndrome （OSAHS） with the obstructive sites determined by pressure measurements, and to evaluate the clinical value of upper airway menometry in localizing the obstructive sites. Methods Fifty-one moderate to severe OSAHS patients were examined using whole night recording, including airway continuous pressure measurements （ApneaGraph, MRA-Medical Ltd, UK）.ApneaGraph （AG） transducer catheter contains two pressure and two temperature sensors used for obstruction site determination and detection of apnoeic events during sleep. Obstructive sites were divided into upper （retropalatal region） and lower level （retroglossal region）. The lower limit of obstruction was determined by AG pressure pattern. Using constituent retio to reflect the obstructive propotion of different levels. All patients were divided into two groups （retropalatal or retroglossal） according to the primary obstructive level.The patients of retropalatal group were treated with modified uvulopalatopharyngoplasty （UPPP）, or plus hard palate shortening. The patients of retroglossal group underwent tongue and palatal surgical procedures such as UPPP, hyoid suspension, radiofrequent ablation of tongue base, genioglossus advancement etc. All patients were followed-up at least 6 months using Apneagraph. Clinical outcomes included the Epworth sleeping scale （ESS）, apnea-hypopnea index （AHI） and lowest arterial oxygen saturation （LSaO2）.Results Five patients had moderate OSAHS and 46 were severe. Four patients had experienced UPPP failures. The ESS reduced from arerage 17.6 ±4. 7 to 4. 3 ±4. 3 （（-x） ±s, t = 15. 195, P 〈0. 001）. The AHI reduced from average 52. 4 ± 17.5 to 16. 3 ± 18.2 （t = 10. 873, P 〈 0. 001）. The LSaO2 increased from 0.706±0.099 （（-x）±s） to 0.823 ±0.092 （t= -8.396, P〈0.001）. The success was defined as a ≥50 percent reduction and final apnea-hypopnea index 〈 20/h, the total success rate was 76. 5%. Retropalatal group had 27 patients and 24 cases were in retroglossal group. Their success rate were 81.5% and 75.0% respectively. Conclusion The upper airway pressure measurements can identify the level of obstruction accurately and prove to be effective in the treatment of OSAHS.