阻塞性睡眠呼吸暂停低通气综合征的一期多平面手术治疗与血清标记物变化的研究

发布时间：2018-08-19 13:10

【摘要】： [目的]探讨一期多平面手术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的手术疗效。[方法]对190例OSAHS患者(2个平面以上狭窄)进行鼻腔手术、舌体消融、悬雍垂腭咽成形术、硬腭截短、Repose骨螺钉舌根和(或)舌骨悬吊手术方式中的二项或二项以上的联合手术,后进行6个月随访,比较资料完整的81例患者手术前后多导睡眠监测及X线测量下气道的参数,评价疗效。[结果]81例患者手术前后平均最低血氧饱和度由(0.71±0.01)提高至(0.82±0.07),差异均有统计学意义(t值分别为18.32、11.04,P值均0.01)。下咽气道间隙由(12.1±3.2)mm增加至(16.9±2.6)mm,后气道间隙由(9.2±3.3)mm增加至(15.6±2.4)mm,差异均有统计学意义(t值分别为2.5、7.6,P值分别小于0.014和0.000)。治愈28例(AHI5次／h),占39.5%,有效19例(AHI20次／h但降低幅度≥50%),占23.5%,无效2例(AHI降低幅度50%),占2.4%；治愈和显效率达74.1%。[结论]一期多平面手术是治疗OSAHS患者的有效手术方法。 [目的]研究重度OSAHS患者采用一期多平面手术治疗前后血清中血管紧张素II (angiotensin II, AngⅡ)、新喋呤(neopterin, Npt)、抵抗素(resistin)、S100β浓度的变化,评估手术治疗对这些因子的影响,探讨OSAHS与AngⅡ、Npt、抵抗素、S100β之间的关系。[方法] 2006年5月-2009年07月于我院住院的重度OSAHS患者30例一期多平面手术治疗前及术后六个月的外周血样本,并采集30例正常健康者外周血样本,采用ELISA方法检测血清AngⅡ、Npt、抵抗素、S100β蛋白水平。[结果]1. AngⅡ与最低SaO2、收缩压、AHI的变化有一定线性关系。随着AHI次数的增加,患者血清Npt浓度也增加。抵抗素与BMI的变化有一定线性关系,随着BMI的增加,抵抗素浓度增加。2. OSAHS患者术前AngⅡ、Npt、抵抗素、s100β蛋白浓度均高于健康对照组(P0.05).3. OSAHS患者手术治疗后血清AngⅡ、Npt、抵抗素、S100β蛋白浓度均有不同程度下降(P0.05)。[结论]1.一期多平面手术后患者血压下降与AngⅡ浓度降低,从而ET-1释放减少有关,AngⅡ可能在OSAHS的血压变化中起一定作用。2.NPT是一个与OSAHS病情严重程度相关的因子,可以用来评估OSAS病情,评价手术效果。3. OSAHS患者手术后6个月,血清中抵抗素浓度显著降低,可能与术后患者体重减低有关。4. OSAHS患者术前S100β蛋白浓度显著高于对照组,采用手术治疗6个月后,S100β蛋白浓度显著降低。可能与患者术后日间嗜睡症状缓解,记忆力明显升高有关。
[Abstract]:[objective] to evaluate the effect of one-stage multiplanar operation on obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: a total of 190 patients with OSAHS (2 or more plane stenosis) underwent nasal surgery, tongue ablation, uvulopalatopharyngoplasty, hard palate truncated reconstruction screw hyoid root and / or hyoid suspension. After 6 months follow-up, 81 patients with complete data before and after operation were compared with polysomnography and X ray to measure the parameters of lower airway and evaluate the curative effect. [results] the mean minimum oxygen saturation increased from (0.71 卤0.01) to (0.82 卤0.07) in 81 patients (t = 18.32 卤11.04, P = 0.01). The hypopharyngeal airway space increased from (12.1 卤3.2) mm to (16.9 卤2.6) mm, the posterior airway space increased from (9.2 卤3.3) mm to (15.6 卤2.4) mm, the difference was statistically significant (t = 2.5 卤7.6, P < 0.014 and 0.000, respectively). 28 cases were cured (AHI5 times / h), accounting for 39.5%, 19 cases were effective (AHI20 times / h but decreased by more than 50%), accounting for 23.5 cases (AHI decreased by 50%), 2 cases (AHI decreased by 50%), the effective rate was 74.1%. Conclusion one-stage multi-planar operation is an effective method for the treatment of OSAHS patients. [objective] to study the changes of serum angiotensin 鈪，

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