改良腭咽成形术联合鼻腔扩容术治疗阻塞型睡眠呼吸暂停低通气综合征

Effect of Modified Palatopharyngoplasty Combined with Nasal Cavity Expansion in the Treatment of Obstructive Sleep Apnea Hypopnea Syndrome

目的:探讨改良腭咽成形术联合鼻腔扩容术治疗阻塞型睡眠呼吸暂停低通气综合征(Obstructive sleep apnea hypopnea syndrome,OSAHS)的疗效。方法:选取笔者医院2014年12月-2019年12月收治的OSAHS患者60例,采用随机数表法将其分为观察组与对照组,各30例。对照组患者采用鼻腔扩容术,观察组采用改良腭咽成形术(H-uvu-lopalatopharyngoplasty,H-UPPP)联合鼻腔扩容术。比较两组患者术后治疗效果;比较患者术前、术后6个月的夜间平均动脉血氧饱和度(Mean arterial oxygen saturation,MSpO_(2))、血氧饱和合度<90%所占夜间睡眠时间比(The percent of the total recorded timespent below 90% oxygen saturation,TS90%)及鼻阻力评分、嗜睡评分(Epworth sleepiness scale,ESS)、鼻塞程度视觉模拟评分(Visual analogue score,VAS)以及鼾声评分(Snoring score,SOS)、梯形鼻孔面积、梯形鼻头面积、梯形鼻孔面积占比;比较术后6个月两组患者并发症发生率。结果:观察组治疗总有效率为93.33%明显高于对照组73.33%,差异具有统计学意义(P<0.05)。观察组术后MSpO_(2)显著高于治疗前及对照组术后,TS90%及鼻阻力明显低于治疗前及对照组术后,差异具有统计学意义(P<0.05)。观察组术后ESS评分、VAS评分及SOS评分显著低于术前及对照组术后,差异具有统计学意义(P<0.05)。术前及术后两组患者梯形鼻头面积、梯形鼻孔面积、梯形鼻孔面积占比比较差异无统计学意义(P>0.05)。两组患者术后并发症总发生率分别为10.00%、20.00%,组间比较差异无统计学意义(P>0.05)。结论:改良腭咽成形术联合鼻腔扩容术治疗OSAHS的临床效果以及术后恢复情况都更优,且安全性较好,值得推广使用。

Objective To study the effect of modified palatopharyngoplasty combined with nasal cavity expansion in the treatment of obstructive sleep apnea hypopnea syndrome(OSAHS)and nasal shape index.Methods 60 patients with obstructive sleep apnea hypopnea syndrome(OSAHS)in our hospital from December 2014 to December 2019 were selected and divided into the observation group and the control group by random number table,with 30 cases in each group.The control group was treated with nasal cavity expansion,and the observation group was treated with modified palatopharyngoplasty combined with nasal cavity expansion.Before and 6 months after operation,the mean arterial oxygen saturation(MSpO_(2)),the ratio of sleep time(TS90%),nasal resistance score,sleepiness score(ESS),visual analogue scale(VAS),snoring score(SOS),trapezoidal nostril area and trapezoidal nose area were compared between the two groups.The incidence of complications was compared between the two groups at 6 months after operation.Results The total effective rate of the observation group was 93.33%,which was significantly higher than that of the control group(73.33%),the difference was statistically significant(P<0.05).The MSpO_(2) of the observation group was significantly higher than that before treatment and after the control group,TS90%and nasal resistance were significantly lower than those before treatment and after operation in the control group(P<0.05).The ESS score,VAS score and SOS score in the observation group were significantly lower than those before and after the operation in the control group(P<0.05).There was no significant difference in the area of trapezoidal nose,area of trapezoidal nostril and proportion of trapezoidal nostril between the two groups before and after operation(P>0.05).The total incidence of postoperative complications in the two groups were 10.00%and 20.00%,respectively,and there was no significant difference between the two groups(P>0.05).Conclusion The improved palatopharyngoplasty combined with nasal cavity expansion in the treatment of OSAHS patients has better value in clinical effect and postoperative recovery,and has good safety,which is worthy of promotion.