软腭折叠术在OSAHS软腭低垂帷幔型患者中的应用效果

摘要

目的 观察软腭折叠术在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)软腭低垂帷幔型患者中的应用效果.方法 选择2013年6月—2017年3月陕西省铜川市人民医院耳鼻喉科治疗OSAHS软腭低垂帷幔型患者34例作为研究对象,按照随机数字表法分为研究组和对照组,各17例.研究组患者给予软腭折叠术治疗,对照组患者给予悬雍垂腭咽成形术治疗.观察2组术后疗效,术前术后的睡眠呼吸暂停低通气指数(AHI)、鼾声响度评分、Ep-worth嗜睡量表(ESS)评分,咽痛持续时间、恢复正常饮食时间、术后咽痛(NRS)分级,最低血氧饱和度(LSaO2)、动脉血二氧化碳分压(PaCO2)、血氧分压(PaO2)以及并发症发生率.结果 2组患者的临床总有效率比较,差异无统计学意义(94.1%vs.88.2%,χ2=1.474,P=0.813);术后6个月,2组患者的AHI、鼾声响度评分、ESS评分与术前比较均显著改善,差异具有统计学意义(P均<0.001),研究组患者的鼾声响度评分明显低于对照组,差异具有统计学意义(t=2.743、P=0.007);研究组患者的咽痛持续时间、恢复正常饮食时间明显短于对照组,差异具有统计学意义(t=6.423、2.214,P<0.05);研究组患者的疼痛程度明显低于对照组,差异具有统计学意义(U=211.700,P=0.030);术后,研究组患者的LSaO2明显高于对照组,差异具有统计学意义(t=2.392,P=0.019);而2组患者的PaCO2、PaO2比较,差异均无统计学意义(t=0.440,P=0.663;t=0.127,P=0.900);研究组患者的术后并发症发生率明显低于对照组,差异具有统计学意义(11.8% vs.35.3%,χ2=8.134,P=0.010).结论 软腭折叠术在OSAHS软腭低垂帷幔型患者中的应用效果显著,患者恢复较快,疼痛小,并发症少.%Objective To observe the effect of soft palate plication on OSAHS patients with drooping soft palate. Methods Thirty-four OSAHS patients from Tongchuan People's Hospital of Shaanxi with drooping soft palate who treated in hospital from June 2013 to March 2017 were selected as study subjects.According to the random number table method,they were divided into study group and control group,17 cases in each.The patients in the study group were treated with soft palate plication,and the patients in the control group were treated with uvulopalatopharyngoplasty.The Apnea Hypopnea Index (AHI),snoring loudness score,the lowest SaO2(LSaO2),partial pressure of carbon dioxide in vein blood(PaCO2),partial pressure of oxygen(PaO2),the Epworth Sleepiness Scale(ESS),sore throat duration,normal diet recovery time,postopera-tive sore throat classification(Numeric Rating Scale,NRS),postoperative curative effect and complication rate of two groups before and after operation were observed and recorded.Results The total effective rate of the two groups was not statistically significant(χ2=1.474,P=0.813);Six months after the operation,the indexes of sleep breathing in the two groups were sig-nificantly improved, which were compared with those before operation; and the difference was statistically significant(t =3.963,t=4.931,P=0.000,P=0.000;t=6.761, t=7.302,P=0.000, P=0.000;t=3.251, t=3.223,P=0.003, P=0.003);In the study group,the snoring loudness score in the sleep apnea index and the improvement of LSaO 2were bet-ter than that of the control group,and the difference was statistically significant(t=2.743,P=0.007);The normal diet re-covery time and sore throat duration of the study group were significantly shorter than those of the control group,and the difference was statistically significant(t=6.423,t=2.214,P<0.05); The number of patients with mild pain in the study group was significantly higher than that in the control group,and the number of patients with severe pain was significantly less than that of the control group,the difference was statistically significant(χ2=4.554,P=0.032;χ2=4.608,P=0.030);After the op-eration,The LSaO2of the patients in the study group was significantly higher than that in the control group,the difference was statistically significant(t=2.392,P=0.019);PaCO2and PaO2were compared between the two groups,there were no sta-tistically significant(t=0.440,P=0.663,t=0.127,P=0.900);The incidence of postoperative complications in the stud-y group was significantly lower than that in the control group, the difference was statistically significant(χ2=8.134,P=0.010).Conclusion The soft palate plication is effective remarkably in OSAHS patients with drooping soft palate,and the patient can recover quickly,with less pain and less complications.