阻塞性睡眠呼吸暂停低通气综合征患者UPPP术后夜间睡眠状态血氧变化

发布时间：2019-01-01 19:08

【摘要】： 目的：应用便携式血氧仪监测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者悬雍垂腭咽成形术(UPPP)术前术后夜间血氧饱和度相关指标,评价术后血氧饱和度改善的近期疗效并观察术后第二天到第六天夜间血氧饱和度相关指标变化趋势。方法：对来我科以“睡眠时打鼾、伴明显憋气”就诊的病人,根据多导睡眠监测(PSG)结果,符合中华医学会OSAHS诊断标准并具有手术指征的31例患者进行UPPP手术,将其术前一晚及术后第二天至第六天每晚佩戴便携式血氧仪所监测得到的氧减指数(ODI),最低血氧饱和度(LO2),平均血氧饱和度(AO2),血氧饱和度分别处于90%-99%、80%-89%、70%-79%等区间的事件数(分别记录为Q(90-99)%、Q(80-89)%、Q(70-79)%),血氧饱和度分别低于90%、80%、70%的记录时间占总记录时间的百分比(T90%、T80%、T70%)等数据分组并进行统计学处理。结果：31例患者术后均感症状有不同程度的改善。轻度OSAHS组中平均血氧饱和度(AO2)和血氧饱和度低于90%的记录时间占总记录时间的百分比(T90%)两指标术前与术后第二到第六天每天夜间相比存在统计学意义。中度OSAHS组中除血氧饱和度处于70%-79%区间的事件数(Q(70-79)%)、血氧饱和度低于70%的记录时间占总记录时间的百分比(T70%)和最低血氧饱和度(LO2)外,其余各血氧饱和度指标术前和术后每晚存在统计学意义,绝大部分指标存在显著性差异(p0.01)。重度OSAHS组中,除最低血氧饱和度(LO2)和血氧饱和度处于90%-99%区间的事件数Q(90-99)%外,其余各血氧饱和度指标术前术后有显著性差异(p0.01)。血氧饱和度各指标在术后各天之间尚不能认为有差异,术后5天血氧饱和度各指标变化波动性很大,无明显规律性。轻度、中度、重度组各组间术后各指标比较,无统计学意义,尚不能认为各组间有差异。31例患者中共有24例术后最低血氧饱和度达到40%,其中轻度组5例,中度组8例,重度组患者术后最低血氧饱和度均达到此值,共11例。在这24例患者中有19例出现术后有3天最低血氧饱和度达到40%,其中轻度组3例,中度组7例,重度组9例。结论：OSAHS患者UPPP术后多数血氧饱和度指标较术前有明显改善。轻度、中度、重度三组OSHAHS患者术后5天各血氧饱和度指标在三组间比较无统计学差异。血氧饱和度各指标在术后第2到第6天夜间变化波动性很大,无明显规律性,绝大多数患者出现术后重度缺氧情况,最低血氧饱和度达到40%。术后夜间绝大多数患者缺氧症状仍然存在,有窒息危险性,术后进行连续夜间血氧饱和度监测是必要的。
[Abstract]:Objective: to monitor the nocturnal oxygen saturation in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after uvulopalatopharyngoplasty (UPPP) by using portable oxygen analyzer. Objective: to evaluate the short-term effect of the improvement of blood oxygen saturation after operation and to observe the change trend of the indexes of oxygen saturation at night from the second day to the sixth day after operation. Methods: according to the results of polysomnography (PSG), 31 patients who were treated with "snoring during sleep with obvious holding of breath" were performed UPPP operation according to the diagnostic criteria of OSAHS of the Chinese Medical Association and the indication of operation. The lowest oxygen saturation (LO2), mean oxygen saturation (AO2), and oxygen saturation (O _ 2) of (ODI), which were monitored by a portable oxygen meter, were measured between 90 and 99, respectively, one night before operation and from the second day to the sixth day after operation. The number of events (Q (90-99)%, Q (80-89%, Q (70-79%) and the saturation of oxygen in the blood were below 90% and 80%, respectively. Data such as 70% of the total recording time (T90 and T80 and T70%) were grouped and processed statistically. Results: sensory symptoms were improved in 31 patients after operation. The mean oxygen saturation (AO2) and the percentage of recording time less than 90% of the total recording time (T90%) in the mild OSAHS group were statistically significant before and after the second to sixth day of operation. In the moderate OSAHS group, except for the number of events with oxygen saturation between 70% and 79% (Q (70-79)%, the percentage of recording time below 70% (T70%) and the lowest oxygen saturation (LO2) in the moderate OSAHS group, The other indexes of oxygen saturation were statistically significant before and after operation, and there were significant differences in most of them (p0.01). In severe OSAHS group, except for the lowest oxygen saturation (LO2) and the event number Q (90-99)% between 90% and 99%, there was a significant difference between the other indexes of oxygen saturation before and after operation (p0.01). The indexes of blood oxygen saturation could not be considered to be different between the days after operation. On the 5th day after operation, the changes of the indexes of blood oxygen saturation were very volatile and had no obvious regularity. There was no significant difference between the three groups. Among the 31 patients, 24 cases had the lowest oxygen saturation after operation, 5 cases in the mild group, 8 cases in the moderate group, and 5 cases in the mild group, 5 cases in the moderate group, and 8 cases in the moderate group. In the severe group, 11 patients (11 cases) had the lowest oxygen saturation after operation. Of the 24 patients, 19 had the lowest oxygen saturation of 40 at 3 days after operation, including 3 mild, 7 moderate and 9 severe. Conclusion: most of the blood oxygen saturation indexes after UPPP in OSAHS patients were significantly improved compared with those before operation. There was no significant difference in the indexes of oxygen saturation between the three groups on the 5th day after operation in mild, moderate and severe OSHAHS patients. During the second to sixth days after operation, the indexes of oxygen saturation varied greatly and had no obvious regularity. Most of the patients had severe anoxia after operation, and the lowest oxygen saturation reached 40. The anoxia symptoms still exist in most of the patients after operation and are at risk of asphyxia. It is necessary to monitor the blood oxygen saturation continuously after operation.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R766

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