鼻腔扩容术的临床疗效观察

Clinical observation with nasal cavity ventilation expansion techniques

目的评价鼻腔扩容术治疗OSAHS患者主客观症状的改善情况。方法观察30例行鼻腔扩容术的成年OSAHS患者,所有患者于术前进行多道睡眠图(PSG)描记,鼻声反射和鼻阻力测试等鼻功能检查,填写白天嗜睡主观评分Epworth嗜睡量表(Epworth sleepiness score,ESS)、鼻塞主观视觉模拟量表(visual analogue scale,VAS)评分、鼾声评分量表,以上主客观检查于鼻腔手术后3个月重复记录。所有患者接受鼻腔扩容术(鼻中隔三线减张成形术、双侧下鼻甲外移、双侧中鼻甲内移和双侧中鼻道鼻窦对称性开放)。结果鼻腔扩容术后患者鼻腔总阻力显著降低[(0.89±0.23)kPa·s/L vs(0.29±0.12)kPa·s/L,P<0.01],鼻塞VAS评分显著降低[8.2±1.1 vs 2.1±0.73,P<0.01],白天嗜睡ESS评分显著降低(12.7±1.2 vs 8.6±2.9,P<0.01),打鼾程度减轻(62.2±25.6 vs 45.6±18.6,P<0.01)。轻度OSAHS患者呼吸暂停低通气指数(apnea and hypopnea index,AHI)较术前显著下降(P<0.05),觉醒指数较术前显著下降(P<0.01),最低动脉血氧饱和度(lowest SaO2,LSaO2)较术前显著升高(P<0.01)。中度和重度OSAHS患者的AHI指数、觉醒指数、LSaO2均较术前无显著改变(P>0.05)。LSaO2、睡眠结构各阶段的比例、快动眼睡眠阶段的长度在所有OSAHS患者均没有显著变化(P>0.05)。30例OSAHS患者鼻腔扩容术的总体有效率为26.7%。结论鼻腔扩容手术可以改善OSAHS患者鼻塞及白天嗜睡、睡眠打鼾等相关睡眠主观症状,并在一定程度上改善OSAHS患者的阻塞性睡眠呼吸暂停的严重程度,应适当选择其手术适应证。

OBJECTIVE To compare the changes of objective and subjective symptoms before and after nasal cavity ventilation expansion techniques and to evaluate the efficacy of this techniques.METHODS Thirty adult patients with OSAHS were included in this study.Nasal cavity ventilation expansion techniques were performed.Every patient took the examination of rhinomanometry and polysomnography.They all filled VAS of nasal obstruction,Snore Outcome Survey and Epworth Sleep Scores.Postoperative data were obtained at least 3 months later.RESULTS Compared with pre-operative examination data in all OSAHS patients,the post-operative average total nasal resistance[（0.89±0.23）kPa·s/L vs（0.29±0.12）kPa·s/L],VAS scores of nasal obstruction（8.2±1.1 vs 2.1±0.73）and the Epworth Sleep Score（12.7±1.2 vs 8.6±2.9）were significantly decreased respectively（P〈0.01）.The AHI,the arouse indexes and the lowest SpO2 signifcantly decreased only in mild OSAHS patients（P〈0.01）and did not change significantly in moderate and severe OSAHS patients（P〉0.05）.The average blood oxygen saturation,the proportion of each sleep stage of the sleep structure components,the length of REM sleep stage did not change signifcantly in all OSAHS patients after nasal surgery（P〉0.05）.The efficacy rate of the patients was 26.7%.CONCLUSION In OSAHS patients,nasal cavity ventilation expansion techniques can significantly improve the subjective severity of sleepy and snoring.It also can improve the severity of apnea and hypopnea in some patients with OSAHS to some extent.Nasal cavity ventilation expansion techniques provide a new concept of therapy in treatment of OSAHS and should be performed individually.