改良UPPP联合鼻中隔偏曲矫正术治疗OSAHS的疗效分析

Effect of UPPP Combined with Submucous Resection of Nasal Septum in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

目的探讨改良UPPP联合鼻中隔偏曲矫正术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法回顾性分析多导睡眠监测仪监测确诊的33例中重度OSAHS患者,电子鼻咽镜和上气道CT确定阻塞平面位于鼻和腭咽平面,均行同期改良UPPP联合鼻中隔偏曲矫正术,术前先行经鼻持续气道正压通气治疗1周。6～12个月后复查多导睡眠监测。结果所有患者无围手术期并发症,术后鼾声响度及ESS评分较术前明显改善。按照2009年OSAHS诊断依据和疗效评定标准,治愈4例,显效20例,有效9例。呼吸暂停低通气指数(apnea hyponea index,AHI)由术前41.8次/时(25.1～63.4次/时)下降为18.2次/时(3.7～36.5次/时),最低血氧饱和度及血氧饱和度低于0.90的时间占总睡眠时间百分比分别由术前0.76(0.41～0.85)和14.0%(6.1%～28.2%)改善至0.87(0.76～0.94)和2.5%(0.1%～7.2%)。结论改良UPPP联合鼻中隔偏曲矫正术治疗阻塞性睡眠呼吸暂停低通气综合征可取得良好效果,术前行持续气道正压治疗能有效预防手术并发症的发生。

Objective To explore the efficienly of uvulopalatopharyngoplasty （UPPP） combined with submucous resection of nasal septum in patients with obstructive sleep apnea hypopnea syndrome（ OSAHS）. Methods Thirty - three cases diagnosed as OSAHS confirmed by polysomnography（PSG） were retrospective analyzed. The obstructive site were nasal and velopharyngeal area certified by nasopharyngoscopy and upper airway CT. All cases underwent uvulopalatopharyngoplasty（UPPP） combined with submucous resection of nasal septum. Nasal continuous CPAP treatment were carried out a week before operation. PSG were performed in six to twelve follow - up period to assess the therapeutic outcomes. Results There was no complication during perioperation period. The snoring loundness score and Epworth sleepy score（ESS） were reduced greatly compared to preoperation. Based on success criteria of 2009, four cases were cared, twenty cases showed highly responsive result and nine cases were responsive（valid）. AHI was reduced from preoperation 41.8 （25. 1 63.4 ） to postoperation 18.2 （ 3.7 - 36.5 ） , lowest oxygen saturation level （ LSaO2 ） increased from 0.76 （ 0.41 - 0.85 ） to 0.87 （ 0.76 0. 94 ）. The percent of the total recorded time below 0.90 oxygen saturation level（ TS90 ） reduced from 14.0% （ 6.1% - 28.2% ） to 2.5 % （0.1% -7.2% ）. Conclusion UPPP combined with submucous resection of nasal septum could give a beret result. For the moderate and severe OSAHS patients, CPAP treatment before operation could avoid surgical complications.