口腔矫治器联合悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征的临床疗效观察

Therapeutic effects of oral appliance combined with uvulopalatopharyngoplasty on obstructive sleep apnea hypopnea syndrome

目的 探讨口腔矫治器联合悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP）治疗阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）的疗效.方法 通过随机排列表随机选取30例经多道睡眠图（polysomnography,PSG）确诊为OSAHS的患者,均进行UPPP手术治疗,分为单纯手术组（15例）和联合治疗组（15例,UPPP联合口腔矫治器治疗）,对两组均进行术后2年以上随访,并于术后0.5年、2年分别再行PSG监测,测量并计算呼吸暂停低通气指数（apnea hypopnea index,AHI）、最低血氧饱和度（lowest SaO2,LSaO2）和最长呼吸暂停时间（Tmax）,判定治疗效果.结果 术后0.5年两组AHI、LSaO2和Tmax及疗效差异均无统计学意义（P＞0.05）.术后2年30例患者无失访,联合治疗组AHI、LSaO2和Tmax分别为（18.06±2.24）次/h、（88.64±10.37）％和（20.5±17.6）s,均显著优于单纯手术组[（49.73±3.35）次/h、（79.56±4.87）％和（41.3±19.7）s].术后2年疗效比较,单纯手术组9例有效、6例无效;联合治疗组14例有效、1例无效,两组差异有统计学意义（P＜0.05）.结论 口腔矫治器联合UPPP治疗OSAHS对提高治疗的远期有效率有明显效果.

Objective To explore the long-term effects of the uvulopalatopharyngoplasty （UPPP） combined with oral appliance （OA） in the treatment of obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Thirty patients with severe OSAHS confirmed by polysomnography （PSG） according to their apnea hypopnea index（AHI） and lowest SaO2 during sleep were selected using random permutation table and divided into only UPPP group（ U group, n = 15 ） and UPPP with OA group （UA group, n = 15 ）. The follow-up period was 2 years. PSG was performed in 0. 5 year and 2 years after operation. AHI, lowest SaO2 and Tmax were tested and evaluated. Results The effectiveness of two groups was the same after 0. 5 year. Two years after operation, the values [ AHI ： （ 18.06 ± 2. 24 ） times/h ; lowest SaO2 ： （ 88.64 ± 10. 37）% and Tmax ： （20. 5 ± 17.6） s] in UA group were better than that[AHI： （49.73 ±3.35） times/h; lowest SaO2 ： （79. 56 ±4. 87 ） % and Tmax ： （41.3 ± 19.7 ） s] in U group. The number of effectiveness was 9 and the number of ineffectiveness was 6 in U group, while in UA group, the number of effectiveness was 14 and the number of ineffectiveness was 1 （P 〈 0. 05 ）. Conclusions Long-term result of combined treatment was better than that of UPPP only.