多平面手术治疗重度阻塞性睡眠呼吸暂停低通气综合征的疗效观察

Evaluation of short-term effect of the multilevel surgery on severe obstructive sleep apnea-hypopnea syndrome

目的探讨多平面手术治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床疗效。方法 32例患者经7 h以上多导睡眠图(PSG)监测确诊为重度OSAHS,采用Epworth嗜睡量表评估其嗜睡程度,Müller吸气检查评估腭后区和舌后区狭窄程度,舌部大小采用Friedman舌位置分级法。所有患者行改良悬雍垂腭咽成形术(UPPP)加等离子射频舌根减融术(tongue base radiofrequency,TBRF)。结果所有患者术后随访6个月,其Epworth嗜睡程度评分从术前14.2±3.1下降至3.3±2.3(P<0.01);AHI由术前57.1±5.3下降至23.4±4.5(P<0.01);LSpO2由术前71.3±4.6上升至88.1±5.5,总有效率为81.3%(26/32)。结论 UPPP联合等离子射频舌根减融术的多平面手术治疗重度OSAHS有良好的近期效果,等离子射频舌根部减融术可以较好的提高UPPP疗效,具有安全、微创、简便易行等优点。

Objective To assess the short-term effect of multilevel surgical treatment on severe obstructive sleep apnea-hyponea syndrome（OSAHS）.Methods 32 patients with severe OSAHS confirmed by polysomnography（PSG） were enrolled.Their degree of hypnosia was recorded with Epworth sleep scale（ESS）,airway narrowing degrees in retropalatal and retrolingual region were measured by Friedman tongue position method and Muller＇s maneuver with fiberopticendoscopy.All patients received uvulopalatopharyngoplasty（UPPP） combined with tongue base radiofrequency（TBRF）.Results Six months after operation,the Epworth score reduced from 14.2±3.1 to 3.3±2.3（P0.01）,the average apnea-hypopnea index reduced from 57.1±5.3 to 23.4±4.5（P0.01） and the lowest pulse oxygen saturation（LSpO_2） was improved from（71.3±4.6） % to（88.1±5.5） %（P0.01）.The total effective rate was 81.3%（26/32）.Conclusion With good short-term effect,UPPP combined with TBRF is an effective and safe multilevel surgical method for severe OSAHS,as TBRF can facilitate the improvement of therapeutic effect on UPPP for this disease.