摘要
目的分析重度阻塞性睡眠呼吸暂停低通气综合征患者舌后区上气道形态学改变,探讨其远期主客疗效及睡眠结构的改变。方法选择2015年8月~2016年12月在我院经多道睡眠监测确诊的58例重度患者及52例健康对照者,手术前后核磁共振测量舌咽层面各指标及睡眠监测结果的变化,对其行Epworth嗜睡量表评分观察其远期主客观疗效。结果58例患者核磁共振各测量指标与对照组比较,差异均有统计学意义(P<0.05),舌咽后区气道矢径术前为(5.32±1.12)mm,术后为(7.83±2.25)mm,舌体容积由术前的(79.25±19.04)mm3降为术后的(57.14±13.5)mm3,差异有统计学意义(P<0.05),但OSAHS组术后气道最小截面积、气道侧壁软组织厚度、气道横径术后分别为(21.68±3.18)mm、(39.49±5.21)mm、(5.72±1.29)mm,两组比较,差异均无统计学意义(P>0.05)。术后随访复查,OSAHS患者微觉醒指数为(55.46±8.15),睡眠分期中快波睡眠期术后所占比例为(17.19±4.82),均改善不明显(P>0.05),根据呼吸暂停低通气指数及最低血氧饱和度监测指标,总有效率为43.1%,术前后比较,差异无统计学意义(P>0.05)。Epworth嗜睡量表评分术前为(21.15±4.31)分、术后为(13.42±3.62)分,差异有统计学意义(P<0.05)。结论重度OSAHS患者舌咽平面上气道形态结构异于正常,部分参数术后变化不明显,术后远期主观生活质量改善,客观疗效有待进一步提高。
Objective To analyze the morphological changes of the upper airway in the posterior tongue area of patients with severe obstructive sleep apnea-hypopnea syndrome(OSAHS),and to explore the long-term subjective and objective efficacy and changes of sleep structure.Methods A total of 58 severe patients and 52 healthy controls who were diagnosed by multi-channel sleep monitoring in our hospital from August 2015 to December 2016 were selected.Before and after the surgery,MRI was used to measure the changes in the indicators of the glossopharyngeal level and the results of sleep monitoring.The Epworth Sleepiness Scale was scored to observe the long-term subjective and objective curative effects.Results Compared with the control group,each measurement indicator of MRI in 58 patients showed statistically significant changes(P<0.05).The airway sagittal diameter of the posterior glossopharyngeal area was(5.32±1.12)mm before surgery,and(7.83±2.25)mm after surgery.The tongue volume was decreased from(79.25±19.04)mm3 before surgery to(57.14±13.5)mm3 after surgery,and the difference was statistically significant(P<0.05).But the minimum cross-sectional area of airway,the soft tissue thickness of the airway side wall,and the transverse diameter of the airway after surgery were(21.68±3.18)mm,(39.49±5.21)mm and(5.72±1.29)mm respectively in the OSAHS group,and the differences were not statistically significant between the two groups(P>0.05).During postoperative follow-up visits,the arousal index was(55.46±8.15),and the postoperative proportion of fast-wave sleep stage in the sleep staging was(17.19±4.82)of OSAHS patients,both of which were not showing significant improvement(P>0.05).According to the apnea-hypopnea index and the minimum blood oxygen saturation monitoring index,the total effective rate was 43.1%,and there was no statistically significant difference before and after surgery.The Epworth Sleepiness Scale score was(21.15±4.31)points before surgery and(13.42±3.62)points after surgery,and the improvement was significant(P<0.05).Conclusion The airway morphology and structure on the glossopharyngeal plane of patients with severe OSAHS are different from normal,and some parameters do not change significantly after surgery.The long-term subjective quality of life improves after surgery,and the objective efficacy awaits further improvement.
作者
熊国锋
吴莹
曾一民
李光俊
郑英松
邵敏敏
XIONG Guofeng;WU Ying;ZENG Yimin;LI Guangjun;ZHENG Yingsong;SHAO Minmin(n.t.and head and neck department,wenzhou central hospital in zhejiang province,wenzhou325000,china)
出处
《中国现代医生》
2020年第30期81-84,共4页
China Modern Doctor
基金
浙江省医药卫生科技计划项目(2019KY660).