悬雍垂腭咽成形术治疗OSAHS的远期疗效观察

Long-term effects of uvulopalatopharyngoplasty in treatment of OSAHS

目的探讨悬雍垂腭咽成形术对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者远期疗效及生活质量的影响,为改善OSAHS患者预后提供临床依据。方法选择南浔区人民医院2010年1月—2013年1月就诊的50例中、重度OSAHS患者作为研究对象,均行悬雍垂腭咽成形术治疗,于术前及术后1、12、24个月时检测患者呼吸暂停通气指数(AHI)、总睡眠时间、最低血氧饱和度(SaO_2)、3+4期睡眠比例、快速动眼睡眠比例和魁北克睡眠问卷(QSQ)测评,于术前及术后24个月时行Epworth嗜睡量表(ESS)测评,并对2组患者的检测结果进行统计学处理。结果在50例患者中共47例完成调查(94.00%);术后24个月,ESS测评结果显著优于术前(Z=2.611,P<0.05);术后1、12、24个月时,SaO_2、3+4期睡眠比例、快速动眼睡眠比例均高于术前,AHI均低于术前(P<0.05);术后12、24个月时,SaO_2、3+4期睡眠比例、快速动眼睡眠比例均高于术后1个月,AHI均低于术后1个月(P<0.05);术后1、12、24个月时,QSQ各维度评分及总分均高于术前(P<0.05);术后12、24个月时,QSQ各维度评分及总分均高于术后1个月(P<0.05);术后12、24个月时,QSQ各维度评分及总分比较差异无统计学意义(P>0.05)。结论悬雍垂腭咽成形术能够显著改善中、重度OSAHS患者的远期睡眠疗效及生活质量,明显减轻了患者嗜睡程度,值得临床重视。

Objective To investigate the quality of life and long-term effects in obstructive sleep apnea hypopnea syn- drome （OSAHS） patients undergoing the uvulopalatopharyngoplasty, to provide clinical basis for improving the prognosis of patients. Methods From January,2010 to January,2013,50 cases of patients with moderate or severe OSAHS were se- lected as the research object and treated with uvulopalatopharyngoplasty. The respiratory pause hypopnea index （AHI）, to- tal sleep time, the lowest oxygen saturation （ SaO2 ）, proportion of stage 3 ＋ 4 sleep, REM sleep percentage and Quebec sleep questionnaire（QSQ） were evaluated before the operation, and 1,12 and 24 months after the operation. The Epworth Sleepiness Scale（ESS） was used to measure daytime sleepiness about 24 months before and after surgery. The results were statistically analyzed in the two groups. Results The surveys were completed in 47 patients（94.00% ） ;24 months after surgery, the ESS test results were significantly better than the preoperative results （ Z = 2. 611, P 〈 0.05 ） ; At 1,12,24 months after surgery, Sa02, proportion of stage 3 ＋ 4 sleep, REM sleep percentage were higher than preoperative values, and AHI were lower than those before surgery（ P 〈 0.05 ） ;At 12 and 24 months after surgery, SaO2, proportion of stage 3 ＋ 4 sleep, REM sleep percentage were higher than 1 month after surgery and AHI were lower than those of 1 month after surgery（P 〈 0. 05 ） ;At 1,12, and 24 months after surgery, the scores and total scores of QSQ were significantly higher than those before surgery（P 〈0.05） ;At 12 and 24 months after the operation,the scores and total scores of QSQ were higher than those of 1 months after surgery（ P 〈 0.05 ） ;At 12 and 24 months after the operation, there was no significant difference in the scores of QSQ （P 〉 0. 05 ）. Conclusion Uvulopalatopharyngoplasty can significantly improve the long term curative effect of sleep and quality of life in patients with moderate or severe OSAHS, reduce the patient degree of drowsiness.