改良双颌前徙术治疗阻塞性睡眠呼吸暂停低通气综合征患者主观症状变化的调查

Subjective outcomes after modified maxillomandibular advancement for the treatment of obstructive sleep apnea syndrome

目的:评估改良双颌前徙术治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syn-drome,OSAHS)患者主观症状的变化。方法:选择北京大学口腔医院正颌外科中心2005年9月到2011年12月诊治的OSAHS患者15名,进行改良双颌前徙术治疗。于术前和术后6个月分别进行多导睡眠图仪(polysomnogra-phy,PSG)检查。于术前3个月及术后6个月时分别对所有患者进行问卷调查,问卷的内容包括Epworth嗜睡量表(Epworth sleepiness scale,ESS)、睡眠打鼾情况、睡眠期间被发现呼吸暂停情况、术后持续正压通气(continuous posi-tive airway pressure,CPAP)使用情况及手术满意度。结果:15名患者术前睡眠呼吸暂停低通气指数(apnea and hy-popnea index,AHI)为(40.5±12.8)次/h,最低血氧饱和度(lowest oxygen desaturation,LSAT)为73.0%±7.4%;术后AHI为(6.5±3.5)次/h,LSAT为90.8%±2.1%。术前ESS平均为17.6,术后所有患者ESS均小于11,平均为4.3。其中9名患者术前接受CPAP治疗,术后这9名患者不再需要进行CPAP治疗。所有患者对改良双颌前徙手术治疗的效果均感到十分满意,都希望将此种治疗方法介绍给其他患者。结论:应用改良双颌前徙术治疗OSAHS,不仅睡眠呼吸暂停低通气指数、睡眠时最低血氧饱和度等客观指标得到了很好的改善,并且患者的日间极度嗜睡等主观症状也得到了明显的改善。

Objective：To evaluate subjective outcomes after modified maxillomandibular advancement （MMMA） for the treatment of obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods： In the study, 15 patients underwent MMMA for the treatment of OSAHS and received presurgieal and postsurgi- cal polysomnography. A questionnaire was done pre- and postoperatively. The questionnaire included the Epworth sleepiness scale （ESS）, snoring, witnessed apneas, CPAP use, and satisfaction of the treat- ment. Results： The preoperative polysomnography results of the patients were as follows： apnea-hypop- nea index, 40.5±12.8 per hour; lowest oxygen saturation, 73.0%±7.4% ; the postoperative polysom- nography results were as follows ： apnea-hypopnea index, 6.5±3.5 per hour; lowest oxygen saturation, 90.8%±2.1%. Preoperatively, the mean ESS score of the patients was 17.6. Postoperatively, the mean ESS score decreased to 4.3. CPAP was in nine patients before surgery and postoperatively no patients continued. All the patients were satisfied with the treatment and wanted to recommend the treatment to other patients with OSAHS. Conclusion： The review demonstrated that AHI, LSAT, EDS, snoring and witnessed apneas were improved greatly after MMMA technique for the treatment of OSAHS.