药物诱导睡眠内镜VOTE评分在OSAHS手术治疗中的价值
发布时间：2018-12-28 20:19
【摘要】：目的和意义阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)手术治疗前,运用药物诱导睡眠内镜检查(Drug-induced sleep endoscopy,DISE)评估上气道阻塞平面,制定手术策略,以提高手术治疗疗效。但是,DISE检查缺少描述所观察到结果的统一标准,影响DISE对阻塞部位的定位及阻塞程度的评估,近年来国外文献提出了VOTE(velum,oropharynx,tonguebase,epiglottis)评分系统,用于记录DISE检查结果,但国内还未见类似研究。本课题拟通过运用VOTE评分系统,记录患者在睡眠状态时上气道阻塞形态,并比较清醒状态进行内镜下Muller's检查和Friedman临床分型评估方法之间存在的差异。分析DISE检查VOTE评分结果与多平面手术疗效的关系。研究方法经多导睡眠监测诊断为OSAHS的56例患者,每位患者进行Friedman临床分型,并分别进行清醒时Muller's检查及药物诱导睡眠内镜检查,其中40例患者存有录像记录检查结果。统一使用VOTE评分系统来描述内镜检查过程中所观察到上气道的阻塞平面、阻塞程度及阻塞形态,比较DISE和Muller's检查两种检查结果的差异,并比较不同阻塞程度的患者间BMI、AHI、最低血氧饱和度及平均血氧饱和度是否存在差异。比较DISE与Friedman临床分型对评估上气道阻塞程度的差异。对根据DISE结果进行了多平面手术的患者进行短期及长期疗效分析。结果第一章:DISE结果提示40例存有检查录像结果的OSAHS患者主要的上气道阻塞部位仍在腭咽平面,以完全性阻塞为主(90%),其中以环形阻塞(95%)最为常见。口咽侧壁完全阻塞率60%,舌根完全阻塞率17.5%。清醒状态的Muller's检查主要观察到腭咽平面及口咽侧壁平面的阻塞,完全阻塞率分别为52.5%和30%。根据VOTE评分,40例患者DISE检查在腭咽、口咽侧壁、舌根及会厌平面上的得分均高于清醒状态的Muller's检查,均有统计学差异(P值0.05)。DISE检查结果中,腭咽平面,部分阻塞的患者与完全阻塞的患者,AHI值及最低血氧饱和度有统计学差异(P值0.05)。口咽侧壁、舌根及会厌平面,不同阻塞程度的患者间上述指标均无统计学差异(P值0.05)。Muller's检查中,各平面不同阻塞程度患者间BMI、AHI、最低血氧饱和度及平均血氧饱和度均无统计学差异(P值0.05)。第二章:在DISE与Friedman临床分型的比较中,56例患者口咽平面不同扁桃体分级组间阻塞率有统计学差异(P值0.05)。舌根平面的不同Friedman临床分型组间的阻塞率无统计学差异(P值0.05),不同Friedman舌背分级组间阻塞率有统计学差异(P值0.05)。第三章:手术疗效分析提示,口咽侧壁平面短期疗效无效组和有效组间的阻塞率有统计学差异(P值0.05)。各平面长期无疗效和有效组间阻塞率无统计学差异(P值0.05)。结论1.OSAHS患者DISE检查VOTE评分明显高于清醒时Muller's检查,睡眠状态的上气道阻塞平面更多,阻塞程度更重。在评估舌根平面和会厌平面,DISE优于Muller's检查。BMI、AHI、最低血氧饱和度及平均血氧饱和度与VOTE评分中的阻塞严重程度关联不明显。2.对舌根平面的评估,药物诱导睡眠内镜检查优于Friedman临床分型及其中的舌背分级。高位舌背并不能预示舌根平面更容易出现阻塞。肥大的扁桃体提示口咽侧壁平面的阻塞。3.运用VOTE评分对药物诱导睡眠内镜检查结果进行评估后,对于腭咽平面存在完全阻塞,同时口咽侧壁平面存在阻塞的患者进行手术后,其短期疗效更好。对于经药物诱导睡眠内镜检查指导的多平面手术长期疗效,考虑本组数据样本量太少,需进一步随访扩大样本量后,再进一步探讨睡眠内镜中VOTE评分与长期手术疗效的关系。
[Abstract]:Objective To evaluate the effect of surgical treatment on the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). However, the DISE examination lacks a unified standard for describing the observed results, and affects the evaluation of the location and the degree of obstruction of the DISE on the blocking part. In recent years, the foreign literature has proposed the VTE (velum, orophaynx, tonguebase, epiplotis) scoring system, which is used to record the results of the DISE test, but there is no similar study in the country. This subject is to use the VOTE scoring system to record the patient's upper airway obstruction in the sleep state and to compare the differences between the endoscopic Muller's and the Friedman's clinical typing. The relationship between the results of the VOTE score and the effectiveness of the multi-plane operation was analyzed by the analysis of the DISE. In this study, 56 patients with OSAHS were diagnosed by polysomnography, and Friedman's clinical typing was performed for each patient, and the Muller's examination and the drug-induced sleep-endoscopy were performed separately, of which 40 patients had the results of the video recording. The VOTE scoring system was used to describe the obstruction plane, the degree of obstruction and the blocking morphology of the upper airway observed during the endoscopy procedure. The differences between the two test results were compared with the DISE and Muller's, and the inter-patient BMI, AHI, The minimum blood oxygen saturation and the mean blood oxygen saturation were different. To compare the differences in the degree of airway obstruction between DISE and Friedman's clinical classification. Short-and long-term efficacy analyses were performed on patients with multi-plane surgery based on the DISE results. Results The first chapter: The results of the DISE indicated that 40 patients with OSAHS who had the result of the examination and video showed that the main upper airway obstruction was still in the pharynx plane, and the total occlusion was the main (90%), with the most common in the ring-like obstruction (95%). The total obstruction rate of the side wall of the oropharynx was 60%, and the total occlusion rate of the tongue was 17.5%. In the awake state, the muller's examination mainly observed the obstruction of the plane of the pharynx and the side wall of the oropharynx, and the total occlusion rate was 52.5% and 30%, respectively. According to the VOTE score, the scores of DISE in 40 patients were higher than those of the Muller's in the awake state, and there was a statistical difference (P <0.05). In the results of the DISE test, there was a statistically significant difference between the AHI value and the minimum blood oxygen saturation in the pharyngeal plane, partially blocked patients, and fully blocked patients (P <0.05). There was no statistical difference between the patients with oropharynx side wall, tongue root and epiglottic plane and different blocking degree (P <0.05). In the Muller's examination, there was no statistical difference in BMI, AHI, minimum blood oxygen saturation, and mean blood oxygen saturation among patients with different degrees of obstruction in each plane (P <0.05). In the second chapter, in the comparison of the clinical classification of DISE and Friedman, there was a statistical difference between the different tonsillectomy groups in 56 patients (P <0.05). There was no statistical difference between the different Friedman clinical classification groups in the lingual plane (P <0.05), and there was a statistical difference between the different Friedman's back grading groups (P <0.05). In the third chapter, there was a statistical difference between the short-term effect of the short-term effect on the side-side wall of the oropharynx and the effective group (P-value of 0.05). There was no statistical difference between the long-term efficacy of each plane and the effective group (P <0.05). Conclusion 1. The VISE in OSAHS patients was significantly higher than that of the Muller's in the awake state, and the upper airway obstruction plane was more in the sleep state and the degree of obstruction was more severe. The DISE is superior to the Muller's check in the evaluation of the lingual and epiglottic planes. BMI, AHI, minimum blood oxygen saturation, and mean blood oxygen saturation were not significantly associated with the severity of the obstruction in the VOTE score. For the evaluation of the hyoid plane, the drug-induced sleep-endoscopy was superior to the Friedman's clinical classification and the back grading of the tongue. the high-position tongue can not indicate that the tongue-root plane is more prone to blockage. The hypertrophy of the tonsils suggests a blockage in the plane of the pharyngeal wall. After the evaluation of the results of the drug-induced sleep endoscopy by the VOTE score, there was a complete blockage in the pharyngeal plane, and the short-term effect was better after the operation of the patients with the obstruction in the plane of the oropharyngeal wall. For the long-term effect of the multi-plane operation guided by the drug-induced sleep endoscopy, the relationship between the VOTE score and the long-term operation effect of the sleep endoscope is further discussed after the sample size of the data is too small and the sample size is expanded further.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766.9
本文编号：2394384
[Abstract]:Objective To evaluate the effect of surgical treatment on the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). However, the DISE examination lacks a unified standard for describing the observed results, and affects the evaluation of the location and the degree of obstruction of the DISE on the blocking part. In recent years, the foreign literature has proposed the VTE (velum, orophaynx, tonguebase, epiplotis) scoring system, which is used to record the results of the DISE test, but there is no similar study in the country. This subject is to use the VOTE scoring system to record the patient's upper airway obstruction in the sleep state and to compare the differences between the endoscopic Muller's and the Friedman's clinical typing. The relationship between the results of the VOTE score and the effectiveness of the multi-plane operation was analyzed by the analysis of the DISE. In this study, 56 patients with OSAHS were diagnosed by polysomnography, and Friedman's clinical typing was performed for each patient, and the Muller's examination and the drug-induced sleep-endoscopy were performed separately, of which 40 patients had the results of the video recording. The VOTE scoring system was used to describe the obstruction plane, the degree of obstruction and the blocking morphology of the upper airway observed during the endoscopy procedure. The differences between the two test results were compared with the DISE and Muller's, and the inter-patient BMI, AHI, The minimum blood oxygen saturation and the mean blood oxygen saturation were different. To compare the differences in the degree of airway obstruction between DISE and Friedman's clinical classification. Short-and long-term efficacy analyses were performed on patients with multi-plane surgery based on the DISE results. Results The first chapter: The results of the DISE indicated that 40 patients with OSAHS who had the result of the examination and video showed that the main upper airway obstruction was still in the pharynx plane, and the total occlusion was the main (90%), with the most common in the ring-like obstruction (95%). The total obstruction rate of the side wall of the oropharynx was 60%, and the total occlusion rate of the tongue was 17.5%. In the awake state, the muller's examination mainly observed the obstruction of the plane of the pharynx and the side wall of the oropharynx, and the total occlusion rate was 52.5% and 30%, respectively. According to the VOTE score, the scores of DISE in 40 patients were higher than those of the Muller's in the awake state, and there was a statistical difference (P <0.05). In the results of the DISE test, there was a statistically significant difference between the AHI value and the minimum blood oxygen saturation in the pharyngeal plane, partially blocked patients, and fully blocked patients (P <0.05). There was no statistical difference between the patients with oropharynx side wall, tongue root and epiglottic plane and different blocking degree (P <0.05). In the Muller's examination, there was no statistical difference in BMI, AHI, minimum blood oxygen saturation, and mean blood oxygen saturation among patients with different degrees of obstruction in each plane (P <0.05). In the second chapter, in the comparison of the clinical classification of DISE and Friedman, there was a statistical difference between the different tonsillectomy groups in 56 patients (P <0.05). There was no statistical difference between the different Friedman clinical classification groups in the lingual plane (P <0.05), and there was a statistical difference between the different Friedman's back grading groups (P <0.05). In the third chapter, there was a statistical difference between the short-term effect of the short-term effect on the side-side wall of the oropharynx and the effective group (P-value of 0.05). There was no statistical difference between the long-term efficacy of each plane and the effective group (P <0.05). Conclusion 1. The VISE in OSAHS patients was significantly higher than that of the Muller's in the awake state, and the upper airway obstruction plane was more in the sleep state and the degree of obstruction was more severe. The DISE is superior to the Muller's check in the evaluation of the lingual and epiglottic planes. BMI, AHI, minimum blood oxygen saturation, and mean blood oxygen saturation were not significantly associated with the severity of the obstruction in the VOTE score. For the evaluation of the hyoid plane, the drug-induced sleep-endoscopy was superior to the Friedman's clinical classification and the back grading of the tongue. the high-position tongue can not indicate that the tongue-root plane is more prone to blockage. The hypertrophy of the tonsils suggests a blockage in the plane of the pharyngeal wall. After the evaluation of the results of the drug-induced sleep endoscopy by the VOTE score, there was a complete blockage in the pharyngeal plane, and the short-term effect was better after the operation of the patients with the obstruction in the plane of the oropharyngeal wall. For the long-term effect of the multi-plane operation guided by the drug-induced sleep endoscopy, the relationship between the VOTE score and the long-term operation effect of the sleep endoscope is further discussed after the sample size of the data is too small and the sample size is expanded further.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766.9
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