鼻腔扩容术对OSAHS患者的疗效分析

Therapeutic effect of nasal cavity expansion surgery performed under nasal endoscope on patients with obstructive sleep apnea hyponea syndrome

目的观察鼻腔扩容术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床疗效。方法 50例住院治疗的OSAHS患者,术前行多导睡眠呼吸监测(PSG)、纤维鼻咽镜检查及上气道三维CT重建,根据AHI分为轻度组和中重度组。鼻内镜下行鼻腔扩容术,术后6个月复查PSG及ESS评分。比较手术前后两组患者PSG相关参数及患者对手术疗效的主观评价,分析睡眠结构变化。结果轻度组患者手术前后ESS评分及鼾声指数比较,差异有统计学意义(P<0.05),AHI较术前明显改善(P<0.05),但LsaO_2术后改善不明显(P>0.05);中重度组术后AHI及LsaO_2改善不明显(P>0.05)。轻度组患者术后睡眠结构得到有效改善,但中重度组只有部分改善。结论鼻腔扩容术可以有效改善轻度OSAHS患者PSG相关参数及睡眠结构,而中重度患者只能部分改善睡眠结构,却不能改善AHI及LsaO_2水平。

Objective To observe the therapeutic effect of nasal cavity expansion surgery performed under nasal endoscope for the treatment of patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Fiffty cases with OSAHS accompanied with obstructive nasal lesions were included in this study, all being evaluated preoperatively by polysomnography （PSG）, fiberoptic nasopharyngoscopy and 3D CT reconstruction of the upper respiratory tract. Then, these patients were divided into two groups, i.e. mild lesion group with apnea hypopnea index （AHI） ≤15/h and moderate to severe lesion group with AHI〉15/h, based on the data of PSG. The surgical procedures were carried out under nasal endoscope to expand nasal cavity on all these cases, with a following up period lasted for 6 months after the surgery to re-evaluate index changes in PSG and ESS scores. At last, a comparative analysis was made on PSG indexes, subjective evaluation by patients themselves on the surgical therapeutic effect, and the changes in sleep phases as compared before and after the operation between these two groups. Results When compared with the data of ESS scores and snore index obtained before operation, there was statistical significance in the improvement of these data （P〈0.05）, with AHI significantly improved （P〈0.05） as well in patients of mild lesion group, but not in the level of LsaO2 （P〉0.05） following the operation. However, there was no significant improvement in these indexes for cases of moderate to severe lesion group （P〉0.05）. Moreover, there was effective improvement in sleep pattern for cases in mild lesion group, while only less significant improvement obtained for those in moderate to severe group after the surgery. Conclusion Nasal cavity expansion surgery is an effective surgical procedure to improve indexes of PSG and sleep pattern for patients with mild degree of OSAHS, but not so effective for those with moderate to severe degrees of OSAHS, even no effect on the levels of AHI and LSaO2 among them.