咽喉反流伴阻塞性睡眠呼吸暂停低通气综合征患者的治疗及其咽喉反流体征评分、症状指数特点

Treatment of coexisting obstructive sleep apnea and laryngopharyngeal reflux disease and analysis of its characteristic reflux symptom index and reflux finding score

目的分析咽喉反流病(LPRD)伴阻塞性睡眠呼吸暂停综合征(OSAS)患者的咽喉反流体征评分(RFS)和咽喉反流症状指数(RSI)特点,探讨临床治疗效果。方法抽取100例LPRD患者,将其中合并有OSAS的患者作为观察组(n=39),其余作为对照组(n=61),观察两组RFS、RSI及呼吸暂停低通气指数(AHI)、血氧饱和度(SaO_2)、反流总数、总反流时间;比较治疗2个月后RSI、RFS评分。结果观察组RFS和RSI评分总分显著高于对照组,RFS体征差异均有统计学意义(P<0.05),咽喉反流伴OSAS患者声门下水肿、喉室消失、杓会厌襞红斑/充血、喉黏膜水肿、后联合肥厚或肿胀评分显著高于单纯的咽喉反流患者(P<0.05),RSI评分中咽喉反流伴OSAS患者呼吸困难、烧心胸痛胃酸反流评分显著高于单纯的咽喉反流患者(P<0.05);治疗后,观察组RSI评分总分高于对照组(P均<0.05),对照组在呼吸困难、烧心胸痛胃酸反流方面明显优于观察组(P<0.05)。治疗前后,两组AHI、SaO_2、反流总数比较均差异有统计学意义(P<0.05)。治疗后,观察组AHI、SaO_2均明显改善,与治疗前比较差异有统计学意义(P<0.05),两组反流总数、总反流时间改善显著,对照组优于观察组(P<0.05)。结论伴OSAS会加重LPRD患者咽喉反流相关症状,可能是LPRD患者治疗效果和症状改善较差的原因。

Objective To analyze the reflux finding score (RFS) and reflux symptom index (RSI) in patients with laryngopharyngeal reflux disease (LPRD) and obstructive sleep apnea syndrome (OSAS) and to observe the clinical treatment effect. Methods Between January 2016 and December 2017, 100 patients with LPRD were selected. Patients with OSAS were included as the observation group (n = 39), and the rest were observed as the control group (n= 61). The RFS and RSI were assessed in the two groups. The RSI, RFS, apnea-hypopnea index (AHI), blood oxygen saturation (SaO2), total reflux, and total reflux time were compared after 2 months of treatment. Results The total RFS and RSI scores in the observation group were significantly higher than those in the control group. The difference in the signs of RFS was statistically significant (P<0.05). Subglottic edema, disappearance of the laryngeal chamber, anaphylactic erythema/congestion, laryngeal mucosal edema, and the posterior combined hypertrophy or swelling score were significantly higher in the observation group than in the control group (P<0.05). In the RSI, the dyspnea, heartbum, chest pain, acid reflux, and gastric acid reflux scores were significantly higher in the observation group than in the control group (P<0.05). After treatment, the RSI scores in the observation group were higher than those in the control group (P<0.05), but the control group had significantly better dyspnea, heartbum, chest pain, and acid reflux scores than did the observation group (P< 0.05). Before and after treatment, the AHI, SaO2, and total reflux of the two groups were significantly different (P<0.05). The AHI and SaO2 of the observation group showed a significant improvement after treatment than before treatment (P<0.05). The total reflux and total reflux time showed significant improvements in both the groups, but the improvement was better in the control group than in the observation group (P<0.05). Conclusion Coexisting OSAS may aggravate the symptoms associated with laryngopharyngeal reflux in patients with LPRD, which may be the cause of poor treatment outcome and symptom improvement in patients with LPRD.