鼻腔扩容术作为基础术式在治疗OSAHS中的临床价值分析

Clinical study on efficacy of nasal surgical expansion as a basic operation in treatment of patients with OSAHS

目的:探讨将鼻腔扩容术作为治疗OSAHS的基础术式的临床价值。方法:回顾性分析多导睡眠监测确诊的320例OSAHS患者,电子鼻咽喉镜和上气道CT、MRI确定均存在鼻腔平面阻塞,根据具体原因分别经鼻内镜进行鼻中隔三线减张矫正术、中鼻甲内移固定术、中鼻道双侧鼻窦对称开放术、下鼻甲外移固定术或下鼻甲后端1/3行低温等离子消融术等鼻腔扩容手术。比较患者术前与术后6个月匹茨堡睡眠质量指数量表(PSQI)、鼾声评分(SOS)、Epworth嗜睡量表(ESS)、最低血氧饱和度(LSaO2)和呼吸紊乱指数(AHI)、慢波睡眠(SWS)和快速动眼期(REM)的时间和比例。结果:所有患者术后鼾声响度、睡眠憋气、主观精神症状均有改善;PSQI、SOS及ESS评分较术前改善,均差异有统计学意义(P<0.05);按照2009年OSAHS诊断依据和疗效评定标准,治愈38例,显效189例,有效93例,总有效率为100%;LSaO2、AHI、REM的比例术后6个月与术前相比,均差异有统计学意义(P<0.05);患者睡眠结构改善,SWS时间和比例均较手术前明显增加(P<0.05)。结论:OSAHS的手术治疗应首先解决鼻腔通气问题。

Objective：To observe the clinical effect of nasal surgical expansion as basical surgical treatment of patients with OSAHS. Method： A total of 320 patients with OSAHS were retrospectively analyzed. The patient was diagnosed by PSG. The electronic nasopharyngolarygnoscope exam airway CT, and MRI were applied to determining the nasal plane block. According to the concrete reasons, the nasal endoscopic nasal septum corrective surgery and open surgery were carried out, respectively. Nasal sinus neoplasm resection of off shoring, inferior turbinate fracture surgery or inferior turbinate back-end 1/3 line expansion and low temperature plasma ablation of nasal surgery, respectively. Pittsburgh sleep quality index （PSQI）, snore outcome survey（SOS）, epworth sleepi- ness score （ESS）, the lowest arterial oxygen saturation （LSaO2） and AHI, time and ratio of slow wave sleep （SWS）stage and rapid eye movement （REM） stage were applied to comparing the curative effect between pre-op- eration and post-operation periods. Result：Snoring, sleep apnea, subjective mental symptoms of all patients with OSAHS were improved after operation; PSQI,SOS and ESS score were improved compared to pretreatment （P〈 0.05）; according to the 2009 OSAHS diagnosis and curative effect evaluation standard, 38 cases cured, 189 cases had obvious effect, 93 cases effective, and the total effective rate was 100%; there was statistical difference between the pre-operative period and 6 months post-operative in PSQI, SOS and ESS, LSaO2, AHI and proportion of REM （P〈0.05）; sleep structure was improved, time and proportion of SWS were increased after the operation （P〈0.05）. Conclusion：Solving the problem of nasal airway obstruction is the first step in surgical treatment of patients with OSAHS.