正确评价中重度阻塞性睡眠呼吸暂停综合征患者手术短期疗效

Short-term efficacy of surgical treatment of moderate to severe obstructive sleep apnea syndrome

目的探讨通过主观和客观两方面,共同评价个性化单一或联合手术对中重度阻塞性睡眠呼吸暂停综合征(OSAHS)患者的短期治疗效果和生活质量的改变情况。方法收集经多导睡眠记录仪(PSG)确诊的中重度OSAHS患者,根据实验的收入、排除标准,患者相关基本信息收集符合条件者48例。通过比对术前、术后PSG描记的呼吸暂停低通气指数(AHI)、最低血氧饱和度(LaSO2)、平均血氧饱和度(MSaO2)、睡眠效率和生活质量(采用魁北克睡眠问卷)的数据,评价短期手术疗效和对患者生活质量的影响。结果 1手术治疗后PSG监测的客观指标AHI由术前的(56.3±18.2)降至术后的(28.4±20.8),而La SO2由术前的(64.2±12.8)升至术后的(75.1±13.4),即患者除了睡眠效率外,其余PSG监测的客观指标与术前比较差异均有统计学意义(P<0.05);2手术治疗后总体上改善了患者的生活质量,其中变化最大的是白天嗜睡维度,而夜间症状维度在手术后改善最不明显;3根据客观指标评价患者的短期手术疗效:36例患者中治愈率5.5%,显效率25.0%,有效率44.5%,无效率25.0%,总有效率75.0%。而依据主观问卷评分,患者术后总有效率达88.9%,其中白天嗜睡61.1%,白天症状80.6%,夜间症状38.9%,情绪69.4%,社会交往61.1%。结论根据不同阻塞平面制定多平面个性化的治疗方案,是手术治疗OSAHS成功的关键,可明显改善OSAHS患者的生活质量;评价OSAHS患者手术疗效,应联合主观指标和客观指标共同衡量疗效。

Objective To evaluate the surgical treatment efficacy and change of quality of life of patients with moderate or severe obstructive sleep apnea syndrome （OSAHS）.Methods Clinical data of 48 patients with OSAHS confirmed by polysomnography （PSG）were collected.Preoperative and postoperative apnea hyponea Index （AHI）,lowest oxy-hemoglobin saturation （LaSO2 ）,mean oxyhemoglobin saturation （MSaO2 ）,sleep efficiency and quality of life （deter-mined by Quebec sleep questionnaire ） were compared.Results ① After surgical treatment,AHI reduced from （56.3 ±18.2）to （28.4 ±20.8）,and LaSO2 rose from （64.2 ±12.8）to （75.1 ±13.4）.There were statistically sig-nificant differences （P〈0.05）.② After surgical treatment,patientsquality of life was improved,especially the day-time sleepiness.③According to objective indicators,the cure rate was 5 .5%,effectual rate was 25 .0%,effective rate was 44.5%,ineffective rate was 25.0%,and the total effective rate was 75.0%.According to subjective symptoms, the total effective rate was 88.9%,of which daytime sleepiness was 61.1%,daytime symptom was 80.6%,nighttime symptom was 38.9%,emotion was 69.4%,social interaction was 61.1%.Conclusion To develop multi-plane indi-vidualized treatment programs based on different blocking plane is key to the success of surgical treatment of OSAHS, and can significantly improve patientsquality of life.To evaluate the surgical efficacy,both subjective and objective in-dicators should be considered.