单独鼻腔手术治疗阻塞性睡眠呼吸暂停低通气综合征的远期疗效观察

Observation of long term effect of nasal surgery alone for patients with obstructive sleep apnea hypopnea syndrome

目的：探讨单独鼻腔手术治疗阻塞性睡眠呼吸暂停低通气综合征（0sAHS）的远期疗效。方法：回顾分析23例OSAHS并伴有鼻部相关疾病的患者，经PSG和Epworth嗜睡评估表（ESS）确诊，只行鼻腔手术，其中包括鼻中隔矫正术、鼻甲成形术、鼻窦开放术。术后随访1年以上，PSG和ESS检查评估疗效。结果：23例患者术后随访12-39个月，平均（22．64±9．13）个月，患者主观症状改善明显，ESS分值从13．68降至8．14（t=9．429，P〈0．01）。客观检查方面，患者术前术后平均AHI和LSaO2无明显变化（P〉0．05）。23例中5例治疗有效，总有效率为21．74％（5／23），鼻腔是主要阻塞部位；其余18例患者无效。结论：OSAHS患者尤其是中、重度患者，上气道往往存在多个阻塞平面，单独行鼻腔手术适合于阻塞平面主要位于鼻腔的患者。

Objective： To investigate the long term effect of nasal surgery alone for patients with obstructive sleep apnea hypopnea syndrome. Method：Twenty-three cases of OSAHS with nasal diseases were retrospectively analyzed,which were definitely diagnosed by PSG and the Epworth sleepiness scale （ESS）. The patients had undergone nasal surgery only. The surgical procedure consisted of turbinectomy, septoplasty and FESS. All patients were followed up for more than 1 year and the therapeutic effects were evaluated by PSG and ESS. Result： Twenty- three cases were followed up for 12--39 months. The mean follow-up time was 22.64-1-9.13 months. All patients subjectively experienced a significant improvement in subjective symptoms after surgery, in which the mean ESS score decreased from 13.68 to 8.14 （t= 9. 429, P〈0.01）. With regard to objective measures from polysomnographic studies, there were no significant differences in AHI and LSaO2 values between preoperative and postoperative evalution （P〉 0.05）. Among 23 patients, 5 cases have been treated effectively, which accounted for 21. 74%. Nasal cavity may be the major obstruction site in these effectively treated patients. The other 18 cases had invalid result. Conclusion：OSAHS patients,especially moderate and severe degree, have multiple obstruction plane in upper airway, and nasal surgery alone is just suitable for OSAHS patients with nasal obstruction alone.