鼻腔扩容联合改良悬雍垂腭咽成形术对OSAHS患者血压的影响

Influence of nasal expansion surgery in combination with H-UPPP on blood pressure for OSAHS patients

目的观察合并高血压的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者经鼻腔扩容术、改良腭咽成形(H-UPPP)及两种术式联合治疗前后的血压变化。方法经多导睡眠监测(PSG)及临床检查确诊的OSAHS合并高血压患者158例,所有患者经上气道CT及纤维喉镜检查明确同时存在鼻腔及咽腔狭窄,分别行鼻腔扩容术(A组53例)、改良腭咽成形(H-UPPP)术(B组52例)及联合手术(C组53例)治疗,术后随访1年,比较三种手术的疗效及其对患者血压影响。结果术后1年成功随访124例患者,Α组41例,呼吸暂停低通气指数(AHI)从术前(50.6±14.9)降至术后(48.4±13.9),有效5例,有效率12.2%;手术前后血压差异无统计学意义。Β组43例,AHI从术前(53.9±19.0)降至术后(18.1±16.5),有效27例,有效率62.8%;手术前后血压差异有统计学意义。C组40例,AHI从术前(56.0±20.2)降至术后(17.8±15.4),有效31例,有效率77.5%,手术前后血压差异有统计学意义。结论 H-UPPP术及鼻腔扩容联合H-HPPP术对OSAHS有明确的治疗效果,并可以有效改善患者的血压。

Objective To observe the changes of blood pressure in the patients with obstructive sleep apnea hypopnea syndrome（ OSAHS） and hypertension after nasal expansion surgery,modified uvulopalatopharyngoplasty or both.Methods 158 OSAHS patients with hypertension diagnosed by polysomnography were enrolled. With upper airway CT scan and fiber laryngoscopy,the obstructive levels were determined in nasal cavity and pharynx. 53 cases（ group A）underwent nasal cavity expansion surgery,while 52 cases（ group B） underwent modified uvulopalatopharyngoplasty.Another 53 cases（ group C） underwent the both procedures. The followed up was set for 1 year. Curative effectiveness and the change of blood pressure were compared among the three groups. Results 124 patients were successfully followed up. The total effective rate was 12. 2%,62. 8% and 77. 5% in group A,B,C,respectively. Significant changes of blood pressure were noted in the latter two groups. Conclusion H-UPPP alone or combined with nasal expansion surgery demonstrate good therapeutic results in the treatment of OSAHS,and can effectively decrease the patient＇s blood pressure.