单纯鼻腔扩容术及联合改良悬雍垂腭咽成形术治疗OSAHS的疗效

发布时间：2018-03-27 14:55

本文选题：睡眠呼吸暂停　切入点：阻塞性　出处：《实用医学杂志》2016年10期

【摘要】：目的:探讨单纯鼻腔扩容术及鼻腔扩容术联合改良悬雍垂腭咽成形术(H-UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法:经多导睡眠监测(PSG)确诊为OSAHS并手术治疗的患者43例,成功随访38例,其中轻度7例、中度13例、重度18例。所有患者经电子鼻咽喉镜和上气道三维重建技术确定为I、II型双平面阻塞。一期行鼻腔扩容术,术前及术后6个月行Epworth嗜睡量表(ESS)评分及PSG检查。其中28例二期行H-UPPP手术,术后6个月再次复查以上指标。结果 :一期术后随访治愈8例、显效12例、无效18例,总有效率52.7%,呼吸暂停低通气指数(AHI)、低血氧饱和度(LSa O2)、鼾声指数及ESS评分与术前相比差异均有显著性(P0.01),全部患者打鼾、憋气、头痛及嗜睡等主观症状均明显减轻或消失;二期术后治愈13例、显效14例、有效5例、无效6例,总有效率84.2%,AHI、LSa O2、鼾声指数及ESS评分与一期术后相比差异均有显著性(P0.01),无严重并发症发生。结论 :单纯行鼻腔扩容术对阻塞平面主要位于鼻腔及鼻咽平面的轻度及部分中度OSAHS患者效果良好,可免去二期咽部手术;鼻腔扩容联合H-UPPP手术对存在鼻腔、咽腔双平面阻塞的中、重度OSAHS患者效果良好。应严格筛选手术适应证。
[Abstract]:Objective: To explore the simple expansion nasal and nasal cavity expansion surgery combined with modified uvulopalatopharyngoplasty (H-UPPP) for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) patients. Methods: by polysomnography (PSG) diagnosed 43 cases of OSAHS and surgical treatment of patients, 38 cases were followed up successfully, which 7 mild cases, 13 moderate cases and 18 severe cases. All the patients underwent electron nasopharyngolaryngoscope and airway reconstruction techniques to determine I, II type double plane block. One stage of expansion nasal surgery, preoperative and postoperative 6 months for the Epworth sleepiness scale (ESS) score and PSG examination. 28 cases of two patients underwent H-UPPP surgery, after more than 6 months to check again index. Results: first postoperative follow-up, 8 cases were cured, 12 cases markedly effective, 18 cases ineffective, the total efficiency of 52.7%, apnea hypopnea index (AHI), low oxygen saturation (LSa O2), snoring index and ESS the differences were compared with the preoperative scores Significant (P0.01), all patients with snoring, shortness of breath, headache and drowsiness and subjective symptoms were significantly reduced or disappeared; two 13 cases were cured, 14 cases markedly effective, 5 cases effective, 6 cases ineffective, the total efficiency of 84.2%, AHI, LSa O2, snoring index and ESS score and postoperative period compared with significant difference (P0.01), no serious complications occurred. Conclusion: simple nasal cavity expansion surgery on obstructive plane is mainly located in the nasal cavity and nasopharynx plane part of mild and moderate OSAHS patients to good effect, can be removed from the two pharyngeal surgery; nasal cavity expansion combined with H-UPPP operation of the nasal cavity, pharynx obstruction in double plane patients with severe OSAHS, the effect is good. The surgical indications should be strictly screened.

【作者单位】：首都医科大学附属北京世纪坛医院耳鼻咽喉头颈外科;
【分类号】：R766.9

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