鼻腔扩容术在重度阻塞性睡眠呼吸暂停低通气综合征的疗效

The clinical effect of nasal cavity expansion surgery on severe obstructive sleep apnea-hypopnea syndrome

目的:探讨鼻腔扩容术在阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hyponea syndrome,OSAHS)中的疗效及其安全性。方法:2008年1月-2010年1月对经多导睡眠呼吸记录分析仪(P&D-9900北京百诺代医疗器械有限公司)监测确诊为Ⅳ型重度OSAHS的患者48例,均同时合并鼻平面阻塞,采取先行鼻中隔矫正术、下鼻甲部分切除术,3个月后行腭咽成形术,分次解除不同平面上气道阻塞。结果:术后所有患者呼吸暂停、打鼾症状均消失或不同程度减轻,术后3个月及术后6月的PSG监测显示AHI、LSaO2较术前均有明显改善,所有患者麻醉拔管风险降低,未出现拔管窒息。结论:鼻腔扩容术在重度多平面阻塞性睡眠呼吸暂停低通气综合征中显得尤为重要,先行鼻平面手术治疗,解除鼻腔阻塞因素,改善睡眠低氧血症及高碳酸血症,提高机体手术耐受性,为下一步解除上气道结构异常和塌陷因素奠定基础,降低了麻醉和拔管风险。

Objective：To investigate the clinical effect and safety of nasal cavity expansion surgery on severe obstructive sleep apnea-hypopnea syndrome. Methods： The 48 cases diagnosed as type IV severe OSAHS patients from January 2008 to January 2010 is monitored by breathing record by polysomnography analyzer （P ＆ D-9900 Beijing Benro behalf of the Medical Devices Co., Ltd.）, all including nasal plane . In the first stage operation, all patients received nasal septum surgery, part of the inferior turbinate resection.After three months all patients are received uvulopalatopharyngoplasty. The multiple plane staging operations achieved on severe OSAHS success. Results： The symptoms of apnea and snore were improved, and AHI, LSa02 were signifieandy improved than that of pre-operation. Anesthesia extubation of all patients with risk reduction, not extubation suffocation. Conclusion： The nasal cavity expansion surgery is important on severe obstructive sleep apnea-hypopnea syndrome. The first removes nasal obstruction factors to Improve sleep hypoxemia with hypereapnia, and to improve the body＇s surgery tolerance. The foundation is layed for the next lifting of the upper airway structural abnormalities and collapse factors. All reducing the anesthesia and extubation risk.