手术治疗对重度OSAHS合并2型糖尿病患者血糖的影响

Effects of Surgical Treatment on the Blood Sugar Level of Severe OSAHS Patients with Type 2 Diabetes

目的探讨手术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对重度OSAHS合并2型糖尿病患者血糖及糖代谢相关成分水平的影响。方法 87例重度OSAHS合并2型糖尿病患者行Z形腭咽成形术(ZPP)联合颏舌肌前移舌骨悬吊术(GAHM),手术前后检测分析患者空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(GHbA1c)、血清瘦素(leptin)和胰岛素抵抗指数(HOMA-IR)等水平的变化情况。结果术后PSG监测中AHI、LSaO2、睡眠效率和ESS评分较术前有极显著性差异(P<0.01);血糖检测中FBG、GHbA1c、leptin和HOMA-IR较术前有统计学差异(P<0.01);术前有效组和无效组患者比较,PSG指标中LSaO2、睡眠效率和ESS评分差异有统计学意义(P<0.01);血糖检测中FBG、GHbA1c和HOMA-IR均有统计学意义(P<0.05)。结论①对患者进行术前评估能起到一定的预后作用,有利于手术时机的选择;②积极改善患者术前PSG及血糖等相关指标,能有效提高手术成功率和疗效;③行ZPP与GAHM联合术对重度OSAHS合并2型DE患者有极大获益,是临床上可行的手术方案之一。

Objective To explore the impacts of surgical treatment of obstructive sleep apnea hypopnea syndrome （OSAHS） on the level of blood glucose and glucose metabolism components for the severe OSAHS patients combined with 2 - type diabetes. Methods To- tally 87 patients of severe OSAHS patients combined with type 2 diabetes underwent Z -palatoplasty （ZPP） ＆ genioglossus advancement with hyoid suspension（GAHM） surgery. The level changes of fasting blood glucose （FBG） , fasting insulin （FINS） , glycated hemoglobin （GHbAlc） , serum leptin （leptin） and insulin resistance index （HOMA -IR） before and after surgery were detected and analyzed. Results In postoperative PSG monitoring, AHI, LSaO2, sleep efficiency and ESS score were extremely different （P 〈 0.01 ） compared with that of the preoperative. In blood glucose detection, the changes of FBG, GHbA1 c, leptin and HOMA -IR compared with that of the intraoperative were significantly different（ P 〈 0.01 ）. Comparing the effective group and ineffective group preoperatively, LSaO2 , sleep ef- ficiency and ESS score as PSG indicators were statistically significant（P 〈 0. O1 ）. In blood glucose monitoring, FBG, GHbAlc and HO- MA - IR were statistically significant（P 〈 0.05）. Conclusion ① Preoperative evaluation could play a certain role in the prognosis, and is conducive to select operation opportunity. ②Actively improving preoperative PSG and blood sugar indicators could effectively improve the success rate of surgery and efficacy. ③Severe OSAHS patients combined with type 2 DE greatly benefited from ZPP ＆ GAHM sur- gery and it is one of the feasible surgical options.