鼻腔扩容术治疗阻塞性睡眠呼吸障碍的适应症及疗效

Indications and efficacy of nasal cavity ventilation expansion techniques in treatment of obstructive sleep apnea

目的探讨鼻腔扩容术治疗阻塞性睡眠呼吸障碍的适应症选择及临床疗效。方法采取前瞻性研究方法,对2012年1月—2013年1月金华市人民医院经鼻内镜及鼻部CT检查确诊存在鼻腔阻塞性病变、并经多道睡眠监测(Polysomnography,PSG)确诊为阻塞性睡眠呼吸障碍的患者,行鼻腔扩容术,共22例患者,其中OSAHS程度不同分为轻、中、重度,t检测对术前及术后鼻堵症状评分(视觉模拟评分量表,VAS评分)、鼻阻力客观变化指标、PSG主要监测指标的变化、嗜睡症状评分(Epworth sleepiness scale,ESS)、睡眠呼吸紊乱指数(RDI)、鼾声指数等指标进行统计分析。结果 PSG相关指标中,术后6个月轻中度患者AHI和AI明显降低,HI降低但是幅度较小,LSaO2%较术前升高,P<0.05;重度患者以上指标变化不明显,P>0.05;鼾声指数手术前后变化均不明显,P>0.05;术后,轻中重度患者的VAS、ESS、RDI评分均较术前有所改善,其中轻中度患者改善幅度较大,重度患者改善幅度较小;术前,不同程度OSAHS患者的鼻功能不同,术后鼻功能NMCA、NCV均明显改善,较术前比较P<0.05,NR变化幅度较小,并且随着病变程度增加,变化越加不明显。结论不同程度OSAHS间比较,轻中度患者术后相关指标改善程度明显,相对于重度患者更适用于鼻腔扩容术治疗,并且应选择敏感指标作为手术效果评估指标。

Objective To study the indications and curative efficacy of nasal cavity ventilation expansion techniques in the treatment of obstructive sleep apnea（ OSA）. Methods A prospective study were conducted in 22 patients with nasal obstructive diseases and OSA in our hospital from January 2012 to January 2013. The nasal obstructive diseases were confirmed by nasal endoscopic or CT examination,and OSA by polysomnography（ PSG）. The nasal cavity ventilation expansion techniques were performed in all patients. The patients were divided into mild,moderate and severe groups according to the degree of obstructive sleep apnea hypopnea syndrome（ OSAHS）. VAS score for rhinostegnosis,objective indicators of nasal resistance,PSG indicators,PSG indicators,ESS,RDI,vibratory snoring index and other indicators were recorded and compared before and after the operation. T test was used for the statistical analysis. Results Six months after the operation,AHI and AI decreased significantly,HI declined not obviously,and LSaO2% increased clearly in the patients with mild or moderate OSA; but those indexes did not change obviously in severe patients P〉 0. 05. The changes in vibratory snoring index was not significant before and after the operation,P 〉0. 05. VAS,ESS and RDI score in all patients were improved after the operation; it was more obviously in the patients with mild or moderate OSA as compared to the severe patients. The function of the nasal cavity was various in patients with different degree of OSAHS,NMCA and NCV were significantly improved after the operation,P 〈0. 05,but NR not,especially in severe lesions. Conclusion The PSG related indicators can be improved in patients with mild or moderate OSAHS as compared to the severe patients,so they are more suitable for nasal cavity ventilation expansion techniques,and the sensitive indexes should be chosen for the assessment of operative effect.