悬雍垂腭咽成形术联合下鼻甲低温等离子射频消融术治疗重度OSAHS疗效分析
发布时间：2018-08-30 11:05
【摘要】：目的 研究悬雍垂腭咽成形术(UPPP)联合下鼻甲低温等离子射频消融术治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效及联合手术治疗的临床依据。 方法 对经临床检查和整夜睡眠监测确诊为重度OSAHS的患者,而且,这些患者临床及影像学等辅助检查考虑阻塞部位以腭咽平面狭窄和单纯下鼻甲肥大为主的OSAHS患者100例,随机分为两组,实验组进行UPPP联合下鼻甲消融术,对照组为单纯UPPP手术组,术后半年随访并复查PSG、ESS等进行主客观疗效评价并进行统计学分析。全部患者于术前常规行持续正压通气(Continuous Positive Airway Pressure,CPAP)治疗5-7d,并在专人指导下填写ESS睡眠评分(Epworth sleepiness scale, ESS)量表,实验组全部患者均同期行UPPP联合下鼻甲射频消融术,下鼻甲射频消融术采用美国Arthrocare公司ENTec-CoblatorⅡ低温等离子射频治疗仪及配套射频刀头,对照组为单纯UPPP手术组,手术结束后进入ICU监护治疗12～24h,应用抗生素及止血药2d,氢化可的松静滴100～150mg／d,疗程2-3d,并行咽部雾化吸入。术后应用羟甲唑啉棉片收敛鼻腔。 统计学处理应用SPSS13.0软件包进行分析,计量资料以(x±s)表示,比较运用t检验,计数资料比较运用x2检验,P0.05为差异有统计学意义。 结果 1.术后反应及并发症：患者手术时间60～120min,手术出血量均50ml,全部病例术后耐受性良好,术后24-48h出现局部疼痛和肿胀,2例患者出现一过性鼻粘膜糜烂,未出现大出血、窒息等严重并发症。术后6个月临床复查、随访,实验组患者术后鼾声、呼吸暂停及白天嗜睡等症状明显减轻或消失、鼻塞改善。对照组除鼻腔阻塞无改变外,其他症状也不同程度的改善。 2.术后6个月临床和PSG、ESS评分复查,根据2009年中华医学会耳鼻咽喉头颈外科学分会制定的疗效评定标准。本研究实验组总有效率为78.0%；对照组总有效率为56.0%。实验组与对照组相比,总有效率差异有统计学意义(P0.05)呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、ESS评分指标差异有统计学意义(P0.01), BMI差异无统计学意义(P0.05) 结论 1.实验组经过一期UPPP联合下鼻甲低温等离子射频消融术后,患者临床症状明显改善,术后6个月PSG复查,总有效率、ESS评分与对照组比较差异有统计学意义。我们认为重度OSAHS同时伴有下鼻甲肥大患者单纯行UPPP手术疗效不好,需要联合下鼻甲低温等离子射频消融术。 2. UPPP联合下鼻甲低温等离子射频消融术治疗重度OSAHS患者,与传统手术或分期手术相比,该治疗方案既避免患者分期手术带来的痛苦,又减轻了经济负担,在保证安全的前提下同时收到了满意的疗效。
[Abstract]:Objective to study the effect of uvulopalatopharyngoplasty (UPPP) combined with inferior turbinate hypothermia plasma radiofrequency ablation (RPA) in the treatment of severe obstructive sleep apnea hypopnea syndrome (OSAHS). Methods patients with severe OSAHS were diagnosed by clinical examination and overnight sleep monitoring. These patients were randomly divided into two groups: UPPP combined with inferior turbinate ablation, and 100 patients with OSAHS with palatopharynx plane stenosis and simple inferior turbinate hypertrophy were taken into account in the clinical and imaging examinations, the patients in the experimental group were treated with UPPP combined with inferior turbinate ablation. The control group was treated with simple UPPP operation. The patients were followed up half a year after operation and PSG,ESS was reviewed to evaluate the subjective and objective effects and to carry out statistical analysis. All the patients were treated with continuous positive pressure ventilation (Continuous Positive Airway Pressure,CPAP) for 5-7 days before operation, and the ESS sleep score (Epworth sleepiness scale, ESS) scale was filled out under the guidance of special person. All the patients in the experimental group were treated with UPPP combined with radiofrequency ablation of inferior turbinate at the same time. The inferior turbinate radiofrequency ablation was performed with ENTec-Coblator 鈪，
本文编号：2212877
[Abstract]:Objective to study the effect of uvulopalatopharyngoplasty (UPPP) combined with inferior turbinate hypothermia plasma radiofrequency ablation (RPA) in the treatment of severe obstructive sleep apnea hypopnea syndrome (OSAHS). Methods patients with severe OSAHS were diagnosed by clinical examination and overnight sleep monitoring. These patients were randomly divided into two groups: UPPP combined with inferior turbinate ablation, and 100 patients with OSAHS with palatopharynx plane stenosis and simple inferior turbinate hypertrophy were taken into account in the clinical and imaging examinations, the patients in the experimental group were treated with UPPP combined with inferior turbinate ablation. The control group was treated with simple UPPP operation. The patients were followed up half a year after operation and PSG,ESS was reviewed to evaluate the subjective and objective effects and to carry out statistical analysis. All the patients were treated with continuous positive pressure ventilation (Continuous Positive Airway Pressure,CPAP) for 5-7 days before operation, and the ESS sleep score (Epworth sleepiness scale, ESS) scale was filled out under the guidance of special person. All the patients in the experimental group were treated with UPPP combined with radiofrequency ablation of inferior turbinate at the same time. The inferior turbinate radiofrequency ablation was performed with ENTec-Coblator 鈪，
本文编号：2212877
本文链接：https://www.wllwen.com/yixuelunwen/wuguanyixuelunwen/2212877.html
最近更新
教材专著
