阻鼾器与鼻腔和口咽联合手术治疗重度OSAHS的临床效果观察

The clinical effect observation for surgery of nose and pharyngeal auxiliary oral appliance in severe OSAHS

目的:探讨阻鼾器与鼻腔、口咽联合手术治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效,分析阻鼾器在重度OSAHS患者鼻腔、口咽联合手术后配合治疗的意义。方法:根据AHI和睡眠中的最低动脉血氧饱和度(LSaO2),选取46例经PSG确诊为重度OSAHS(即AHI>30,LSaO2<80%)的患者,根据患者鼻、咽情况,分别进行鼻腔、咽腔手术,术后2周对46例患者全部行PSG监测,然后根据个人意愿进行分组,将其中同意佩戴阻鼾器的26例患者分为联合治疗组,其余20例患者分为单纯手术组,3个月后再次对全部病例进行PSG监测,记录AHI、最长呼吸暂停时间(LAT)、LSaO2、平均血氧饱和度(MSaO2)数值和睡眠结构的变化,采用问卷式调查患者主观症状变化,比较2组治疗前后情况。结果:在鼻腔、口咽联合手术后佩戴阻鼾器的联合治疗组中患者AHI及LAT均低于单纯手术治疗组,而LSaO2高于单纯手术组(P<0.05),2组MSaO2之间差异无统计学意义(P>0.05)。与治疗前相比较,2组在治疗后睡眠比例N1显著减少,N2和N3显著增加(P<0.05),REM期差异无统计学意义(P>0.05)。与单纯手术组相比,联合治疗组浅睡眠比例更短,慢波睡眠比例更长,患者主观感觉诸如精神状态、白天嗜睡及体力等显著改善。2组治疗有效率分别为85.0%和92.3%。结论:鼻腔及口咽手术后佩戴阻鼾器对于重度OSAHS患者有较好的治疗效果,对于防止病情复发及改善手术的远期疗效具有重要的意义。

Objective：To investigate the therapeutic effects of oral modified device combined with nasopharyngeal enlargement surgery and evaluate the oral modified device′s adjuvant therapy meaning in severe OSAHS patients after surgery treatment.Method：46 cases with severe OSAHS were diagnosed by PSG according to AHI and the lowest arterial oxygen saturation（LSaO2）.We performed the nasal or pharyngeal cavity expansion surgery for them according to the pathological change part correspondingly.Then all subjects were divided into combined group（n=26）and surgery alone group（n=20）according to their personal willingness.We monitored the PSG for all subjects aftter 2 weeks and 3 months respectively,then we calculate the diversity between the two group or intragroup change on the basis of the AHI,LAT,LSaO2,mean arterial oxygen saturation（MSaO2）and sleep structures recorded by PSG.At the same time,we collected the subjective sensations by questionnaire.Result：The AHI and LAT in combined group were significantly lower and LSaO2 was significantly higher than these in surgery alone group（P〈0.05）,and it′s no difference in MSO2 between the two groups（P〉0.05）.The N 1%was more shorter and the N2% and N 3% were more longer after nasal or pharyngeal operation compared with preoperative states in both groups（P〈0.05）,but we didn′t find difference in REM%（P〉0.05）.The data of PSG also showed that the shallow sleep proportion was more shorter and the slow wave sleep proportion was more longer in combined group compared with surgery alone group.The subjective sensations results also showed significantly alleviated in combined group,such as mental state,daytime sleepiness and physical strength.The efficiency ratio of treatment was 85.0% and 92.3% in surgery alone group and combined group respectively.Conclusion：Nasal and pharyngeal cavity enlargement surgery combined with oral modified device is a more effective treatment in patients with severe OSAHS,and it is meaningful for the long-term curative effect of surgery to prevent relapse and improve.