个体化鼻腔扩容术对阻塞性睡眠呼吸暂停低通气综合征治疗效果的研究分析

Clinical evaluation of individualized nasal cavity ventilation expansion techniques for the treatment of obstructive sleep apnea-hypopnea syndrome

目的针对有鼻塞症状的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者,施行个体化的鼻腔扩容术,研究鼻腔扩容术治疗OSAHS的临床效果。方法选取2018年1月至2019年6月于山东大学齐鲁医院(青岛)行个体化鼻腔扩容术治疗伴有鼻塞症状的成年OSAHS患者42例;术前及术后3个月分别行多导睡眠监测(PSG)、鼻声反射、鼻阻力、鼻呼吸量仪检查记录呼吸暂停低通气指数(AHI)及最低动脉血氧饱和度(LSaO2)、鼻腔最小横截面积(NMCA)、鼻腔容积(NCV),鼻气道阻力(NAR),鼻总呼吸量(VT)。并填写鼻阻塞症状评估量表(NOSE)、Epworth嗜睡量表(ESS);于术前行持续气道正压通气(CPAP)治疗并以视觉模拟量表(VAS)评分记录患者对CPAP治疗的接受程度,手工压力滴定记录平均有效治疗压力并于术后3个月复查。研究分析鼻腔扩容术的手术效果。结果术后3个月复查,所有患者NOSE、ESS、VAS评分术后较术前均下降[(4.52±1.770)分vs(12.43±2.855)分;(7.55±2.144)分vs(12.67±2.205)分;(4.92±1.38)分vs(7.42±1.02)分,P均<0.05)],所有患者主观鼻塞及嗜睡症状均明显缓解。客观指标中NMCA、NCV、VT明显增加,NAR及CPAP治疗的平均有效治疗压力明显降低,P均<0.05,轻、中度OSAHS患者术后较术前AHI下降、LSaO2上升[轻度(10.76±2.74)次/h vs(6.27±2.34)次/h,(76.44±2.63)%比(82.0±2.80)%;中度(25.12±5.32)次/h vs(17.38±6.51)次/h,(70.92±3.17)%vs(73.85±3.31)%,P均<0.05],重度OSAHS患者AHI及LSaO2虽有好转,但P均>0.05。所有患者鼻内镜下鼻腔扩容术无并发症发生。结论个体化的鼻腔扩容术可以有效改善伴有鼻塞症状OSAHS患者的鼻腔通气及睡眠质量,是治疗鼻源性OSAHS的一种有效手术方式,并可提高CPAP治疗的依从性。对于部分中度及重度OSAHS患者仍需多层面的综合性治疗。

Objective To investigate the efficacy of individualized nasal cavity ventilation expansion techniques for obstructive sleep apnea-hypopnea syndrome(OSAHS) patients with nasal obstruction. Methods Between January 2018 and June 2019, 42 adult OSAHS patients with nasal obstruction were selected and treated at the Qilu Hospital of Shandong University(Qingdao). Polysomnogram(PSG),nasal acoustic reflex, resistance examination, and nasal respiration volume were performed before and 3 months after surgery to record the apnea-hypopnea index(AHI), the lowest arterial oxygen saturation(LSaO2), nasal minimal cross-sectional area(NMCA), nasal cavity volume(NCV), nasal airway resistance(NAR), and nasal total volume(VT). The nasal obstruction symptom evaluation(NOSE) and Epworth sleepiness scale(ESS) were also administered. Continuous positive airway pressure(CPAP) was performed before surgery;the acceptance of CPAP treatment was recorded using the visual analog scale(VAS). The average effective treatment pressure was assessed using the manual pressure titration, and it was reviewed 3 months after the surgery to analyze the effect of nasal dilatation. Results Three months after the surgery, the scores of NOSE, ESS, and VAS for all the patients were significantly lower than those obtained before the surgery(4.52±1.770 vs. 12.43±2.855;7.55±2.144 vs. 12.67±2.205;7.42±1.02 vs. 4.92±1.38, P<0.05). Subjective nasal congestion and somnolence significantly resolved in all the patients. Among the objective indexes, NMCA, NCV, and VT increased significantly, and the average effective pressure of NAR and CPAP decreased significantly(P<0.05). AHI was lower and LSaO2 was higher in patients with mild and moderate OSAHS after than before the surgery [Mild: 10.76±2.74 times/h vs. 6.27±2.34 times/h, 76.44±2.63% vs 82.0±2.80%;Moderate: 25.12±5.32 times/h vs. 17.38±6.51 times/h, 70.92±3.17% vs 73.85±3.31%, P<0.05]. Conclusion Individualized nasal dilatation can effectively improve nasal ventilation and the sleep quality of OSAHS patients with nasal congestion symptoms. It is an effective surgical method for the treatment of nasal OSAHS, and it can improve compliance with CPAP treatment. Multifaceted comprehensive treatments are needed for moderate and severe OSAHS cases.