阻塞性睡眠呼吸暂停低通气综合征术前评估体系的建立及临床应用

Establishment and clinical application of preoperative evaluation system for obstructive sleep apnea hypopnea syndrome

目的建立阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)术前评估体系,筛选适合OSAHS患者术前上气道全面评估的参数和有效检查方法,为制订合理的治疗方案提供依据。方法 64例OSAHS患者和20例健康志愿者进行一般参数的采集,包括血压、身高、体重、体重指数和颈围;对患者进行Epworth嗜睡量表(Epworth sleep scale,ESS)测定、牙齿咬合关系半量评价、Friedman软腭位置评分(FPP)、咽腔宽度的评价、PSG监测、鼻声反射测定、X线头颈测量和上气道内镜检查。结果 64例OSAHS患者中,阻塞平面位于口咽部最多,双平面阻塞患者以鼻腔+口咽部阻塞最多,占65.62%,部分患者合并三平面阻塞占9.58%。64例OSAHS患者与对照组比较,鼻声反射和X线头颈测量数据结果均有统计学意义(P<0.05)。OSAHS患者ESS主观评估结果与PSG的一致性,在中度OSAHS患者中最好,达到90.48%。颌面骨性结构评估中,牙齿咬合系半量评价与PSG严重程度无明显一致性,总体一致性较低为10.94%,剔除此项评价,FPP和咽壁开阔程度与PSG的一致性高,分别为90.48%和84.52%。Müller动作(FNMM)评价与PSG结果一致性为82.14%。结论建立OSAHS患者术前评估体系有助于全面而系统的评估上气道存在的阻塞平面,为制定合理的治疗方案提供依据及预测治疗效果,实现OSAHS患者术前评估的科学化、客观化、数据化、专业化。

Objective To establish an obstructive sleep apnea hypopnea syndrome （OSAHS） preoperative assessment system, screening for OSAHS patients with preoperative airway on the parameters of the comprehensive evaluation and effective inspection method, providing the basis for formulating reasonable treatment scheme. Methods The 64 cases of OSAHS and 20 healthy volunteers were first collected for general parameters, including blood pressure, height, weight, body mass index and neck circumference, and then the listed below were performed, including Epworth sleepiness scale （ESS） determination, teeth occlusal half quantity evaluation, Friedman palate position score （FPP）, pharynx cavity width evaluation, PSG monitoring, the measurement of nasal sound reflection, X-ray on the head and neck measurement and endoscopic examination of the airway. Results Among the 64 patients with OSAHS, the obstructive sites existed the most at the pars oralis pharynges, and the patients with biplanar obstruction of both nasal and pars oralis pharynges were in 65.62%, and some patients combined with three obstructive plane were in 9.58%. Compared with control group, nasal sound reflection and X-ray on the head and neck measurements were statistically significant （P 〈 0. 05 ）, which was consistent with other related research results. The results of the ESS subjective evaluation of the patients with the OSAHS were consistent with PSG, and the highest among moderate patients with the disease was 90.48%. Maxillofaeial bony structure assessment, teeth bite was half the amount severity evaluation and PSG had no obvious consistency, lower overall consistency of 10.94%, excluding the evaluation. FPP and pharyngeal wall open degree and PSG had high consistency, 90.48% and 84.52% , respectively. The FNMM evaluation were 82. 14% with PSG results, which were an effective evaluation indicator for OSAHS. Conclusion Establishing a preoperative evaluation system for OSAHS patients with clinical and scientific researeh value is helpful to evaluate the obstructive plane of the upper airway comprehensively and systematically, to provide the basis for the rational treatment plan and predict the therapeutic effect and realize the scientific, objective, data and specialization of preoperative evaluation of OS- AHS patients.