阻塞性睡眠呼吸暂停低通气综合征患者H-UPPP手术前后食管压力的对比分析

Comparison between esophageal pressures before and after H-uvulopalatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome

目的探讨改良悬雍垂腭咽成形手术对阻塞性睡眠呼吸暂停低通气综合征患者食管压力的影响。方法选取阻塞平面为腭咽部的阻塞性睡眠呼吸暂停低通气综合征患者,术前行上气道-食管压力测定,分析食管压力,行改良悬雍垂腭咽成形术,并于术后6个月复查上气道-食管压力,对测量结果进行对比分析。结果(1)阻塞性睡眠呼吸暂停低通气综合征患者术前发生呼吸暂停时的最大平均食管压力与术前呼吸紊乱指数(r=0.604)、ESS评分(r=0.763)呈正相关,与术前最低血氧饱和度(r=-0.454)呈负相关,差异具有统计学意义(P<0.05)。低通气时的最大平均食管压力与术前呼吸紊乱指数(r=0.600)、ESS评分(r=0.609)呈正相关,与术前最低血氧饱和度(r=-0.322)呈负相关,差异具有统计学意义(P<0.05)。(2)30例患者术后6个月复查上气道-食管压力,发生呼吸暂停时最大平均食管压力、低通气最大平均食管压力、呼吸事件时最大呼吸努力、呼吸努力次数、睡眠呼吸暂停低通气指数及最低血氧饱和度结果术后、术前对比分析差异均具有统计学意义(P<0.05)。结论食管压力可以作为评估阻塞性睡眠呼吸暂停低通气综合征患者术前严重程度的一项参考指标。改良悬雍垂腭咽成形术后患者的食管压力得到一定程度改善,进一步肯定了改良悬雍垂腭咽成形术对改善腭咽阻塞为主的阻塞性睡眠呼吸暂停低通气综合征患者的病情和生活质量各方面有确切疗效。

Objective To explore the effect of H-uvulopalatopharyngoplasty （H-UPPP） on esophageal pressure in patients with obstructive sleep apnea-hypopnea syndrome （ OSAHS ）. Methods Patients suffering from OSAHS with obstruction of transpalatal plane were enrolled in this study. All the patients received H-UPPP. The upper airway and esophageal pressures were measured before H-UPPP and at 6 months after surgery respectively to analyze the pressure changes. Results （1）In the patients with OSAHS, the preoperative maximal average esophageal pressures during apnea and hypopnea were both positively correlated with apnea hyponea index （ AHI ） （ r = 0. 604, r = 0. 600 ） , Epworth sleepiness scale （ESS） （ r = 0. 763, r = 0. 609）, and negatively correlated with the lowest oxygen saturation （ LSaO2 ） （ r = - 0. 454, r = - 0. 322）. （2） Comparisons between monitoring results before and 6 months after H-UPPP showed that the differences of maximal average esophageal pressures during apnea and hypopnea, the degree and incidence of respiratory effort during sleep-related respiratory events, AHI and LSaO2 were all statistically significant （ all P 〈 0. 05 ）. Conclusions Preoperative esophageal pressure can reflect the severity of OSAHS. The improvement of esophageal pressure after H-UPPP is further sure of its efficiency in improvements of general condition and quality life of patients with OSAHS.