低温射频消融术治疗老年阻塞型睡眠呼吸暂停低通气综合征的临床观察

Clinical observation of temperature-controlled radiofrequency ablation for treatment of elderly patients with obstructive sleep apnea hypopnea syndrome

目的探讨局部麻醉下低温射频消融术（TCRF）治疗老年阻塞型睡眠呼吸暂停低通气综合征（OSAHS）的疗效及安全性。方法对经多导睡眠图（PSG）监测确诊的老年OSAHS患者52例，局部麻醉下行TCRF治疗，比较治疗前后呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2）、睡眠呼吸暂停生活质量指数（SAQLI）和Epworth嗜睡量表（ESS）评分，以确定治疗效果。结果术后6个月复查PSG，52例患者中治愈13例、显效18例、有效15例、无效6例，总有效率88．5％（46／52），无严重并发症发生；手术前后AHI分别为（47．8±13．7）、（13．5±7．3）次／h，LSaO2分别为0．677±0．095、0．808±0．056，SAQLI评分总分分别为（3．53±0．43）、（5．01±0．22）分，ESS评分分别为（14．93±3．13）、（5．33±2．52）分，差异均有统计学意义（P〈0．01）。结论局部麻醉下TCRF治疗老年OSAHS，能有效改善患者的近期生活质量，且操作简单、手术时间短、创伤小、可重复、无严重并发症。

Objective To investigate the clinical efficacy and safety of temperature-controlled radiofrequency ablation （TCRF） for treatment of elderly patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods From March 2009 to June 2010, 52 elderly patients with OSAHS confirmed by polysomnography （PSG） were treated with TCRF under local anesthesia. PSG monitoring was used preoperatively and 6 months postoperatively to determine the therapeutic effect. Apnea hyponea index （AHI）, the lowest blood oxygen saturation （LSaO2）, sleep apnea quality of life index （SAQLI） and the Epworth sleepiness scale（ESS） were assessed before and 6 months after operation. Results All these cases were reevaluated with PSG by the end of postoperative period lasted for 6 months. Thirteen cases were cured, 18 cases were significantly improved, 15 cases were improved, 6 cases were not improved,with a total effective rate of 88.5% （46/52）. No serious complications occurred. After operation, AHI decreased from （47.8 ±13.7 ） times/h to（ 13.5 ±7.3 ） times/h,LSaO2 increased from 0.677 ±0.095 to 0.808 ± 0.056, SAQLI increased from （3.53 ± 0.43 ） scores to （5.01 ±0.22） scores and ESS scores decreased from （ 14.93 ±3.13 ） scores to （5.33 ± 2.52） scores, all above index had significant differences （P 〈 0.01 ）. Conclusions TCRF for elderly patients with OSAHS is effective, and can improve their health-related quality of life. This treatment is convenient, simple, minimally invasive, repeatable, without serious complications, and can be especially suitable for surgical treatment of elderly patients with mild and moderate OSAHS.