胃底折叠术治疗胃食管反流病对阻塞性睡眠呼吸暂停综合征的影响

Laparoscopic fundoplication in the treatment of gastroesophageal reflux disease-related obstructive sleep apnea syndrome

目的 观察腹腔镜Nissen胃底折叠术治疗胃食管反流病对阻塞性睡眠呼吸暂停低通气综合征的影响.方法 回顾性分析郑州大学第一附属医院18例胃食管反流病合并阻塞性睡眠呼吸暂停综合征患者的临床资料.18例胃食管反流病患者同时经胃食管反流病诊断问卷和Epworth嗜睡量表评分,并经多导睡眠图检测诊断合并阻塞性睡眠呼吸暂停低通气综合征,均给予腹腔镜Nissen胃底折叠术治疗. 结果 对18例胃食管反流病患者均成功实施腹腔镜手术并于术后1年随访.手术治疗后反流总积分由术前的18（8 ～40）降至术后的0（0～3） （Z =3.730,P＜0.05）,术后每例反流总积分均＜12分;嗜睡评分由术前的13±5降至术后的7±3（t =7.834,P＜0.05）;DeMeester评分由术前的39±34降至术后的10±7（t=4.394,P＜0.05）;睡眠呼吸暂停低通气指数由术前的（33±18）次/h降至术后的（7±8）次/h（t=5.762,P＜0.05）;夜间最低血氧饱和度由术前的73％±13％升至术后的88％±4％（=5.401,P＜0.05）,夜间血氧饱和度＜90％次数由术前的（252±130）次降至术后的（57±59）次（t=6.176,P＜0.05）.结论 胃食管反流病与阻塞性睡眠呼吸暂停综合征关系密切,腹腔胃底折叠术的治疗不仅对胃食管反流病的食管症状有效,还可以明显改善阻塞性睡眠呼吸暂停综合征的状况.

Objective To evaluate laparoscopic Nissen fundoplication for the treatment of gastroesophageal reflux disease related obstructive sleep apnea syndrome.Methods 18 patients of obstructive sleep apnea syndrome received laparoscopic Nissen fundoplication for gastroesophageal reflux disease,and were requested to fill two questionnaires including Reflux Diagnostic Questionnaire and Epworth Sleepiness Scale.The diagnosis of obstructive sleep apnea syndrome had been established by polysomnography.Results At 1 year after the operation,the total score decreased from 18 （8-40） preoperativly to 0（0-3） postoperativly （z =3.730,P 〈 0.05）,with each total score 〈 12.The Epworth Sleepiness Scale score decreased from 13 ± 5 to 7 ± 3 （t =7.834,P 〈 0.05）.The DeMeester integral decreased from 39 ± 34 to 10 ± 7 （t =4.394,P 〈 0.05）.The sleep apnea hypoventilation index decreased from 33 ±18 （time/h） to 7 ±8 （time/h）（t =5.762,P〈0.05）,the lowest SpO2 increased from 73% ± 13% to 88% ±4% （t =5.401,P 〈0.05）,and the time of SpO2 〈90% decreased from 252 ± 130 （time） to 57 ± 59 （time） （t =6.176,P 〈 0.05）.Conclusion Laparoscopic Nissen fundoplication is a safe and effective treatment for obstructive sleep apnea hypopnea syndrome.