OSAHS多阻塞平面同期手术的疗效观察及相关影响因素分析

摘要

目的 观察重度阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea Hypopnea Syndrome,OSAHS)患者多阻塞平面同期手术的治疗效果及其相关影响因素.方法 165例重度OSAHS患者,均分为观察组和对照组.对照组患者采用单纯改良悬雍垂腭咽成形术治疗,观察组患者在对照组术式基础上联合采用多阻塞平面同期手术治疗.术后随访1年,比较观察两组患者的治疗效果,并分析影响患者疗效的相关危险因素.结果 观察组术后呼吸暂停低通气指数、最低血氧饱和度、血氧饱和度90%时间占监测总时间的百分比、Epworth睡眠量表、 鼾声评分、 睡眠呼吸暂停生活质量指数分别为(35.1±16.8)、(0.784±0.100)、(0.177±0.122)、(8.6±3.9)、(4.7±1.9)和(5.3±0.9),明显优于术前(P<0.05);对照组相关指标与术前比较,仅有呼吸暂停低通气指数、最低血氧饱和度和血氧饱和度90%时间占监测总时间的百分比有明显改善.两组疗效比较,观察组明显优于对照组(P<0.05).相关影响因素分析显示,手术方式、高血压、心脑血管疾病、体重是影响本组患者疗效的主要危险因素.结论 多阻塞平面同期手术能有效改善重度OSAHS患者症状及相关检测指标,疗效显著.手术方式、高血压、心脑血管疾病和体重是影响患者疗效的主要危险因素.%Objective To investigate the therapeutic effect of simultaneously multiple plane surgical procedures on severe obstructive sleep apnea hypopnea syndrome (OSAHS) with an analysis on the associated risk factors responsible for its prognosis based on a clinical trial. Methods Included in this trial were 165 patients with severe ASOHS, randomly divided into observation group (OG) and control one (CG). Cases in CG were treated by the procedure of Han-Uvulopalatopharyngoplasty (H-UPPP), while those in OG were operated on in a combination with simultaneously multiple plane operations on the basis of H-UPPP. Then, all these cases were followed up for 1 year to evaluate their therapeutic effects in a comparative way between the two groups and to explore the main related risk factors for the prognosis of the lesion. Results Scores of the determined indicators were (35.1 ±16.8), (0.784±0.100), (0.177±0.122), (8.6±3.9), (4.7±1.9) and (5.3±0.9) for apnea hypopnea index (AHI), low oxygen saturation (Lsao2), the percent of the total recorded time spent below 90% oxygen saturation (TS90%), Epworth sleepiness scale (ESS), snore scales(SS), the sleep apnea quality of life index (SAQLI) in OG, significantly improved than that of preoperative values (P<0.05) respectively, while among those in CG, only improved were AHI, LSaO2, TS90% significantly as compared with that of pre-operation. Therefore, the overall therapeutic effects were much superior in OG to that in CG (P<0.05). As a result of analysis on the related risk factors responsible for the prognosis of the lesion, such ones as surgical procedure taken, ill history of hypertension, accompanied cardiovascular diseases, as well as body weight were the main factors involved in the level of therapeutic efficacy, or prognosis, for cases with severe ASOHS involved in this trial. Conclusion Simultaneously performed surgical procedure at multiple planes can effectively improve the clinical symptoms and related assaying indicators for cases of severe OSAHS with their blocking lesionspresent at multiple planes at the same time. The main associated risk factors with its prognosis are these such as surgical procedure taken, ill history of hypertension, accompanied cardiovascular diseases, as well as body weight, being able to give influence on therapeutic efficacy or prognosis of patients with severe OSAHS.