目的 评估腭垂、腭、咽成形术(UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并慢性心力衰竭( CHF)的安全性及有效性. 明确UPPP对改善患者心功能的疗效. 方法 依据纳入及排除标准,选择2009年1月~2010年6月就诊于笔者医院的OSAHS合并CHF患者. 随机将入组患者分为手术组及非手术组,手术组予以UPPP术治疗,非手术组予以药物治疗及持续气道正压通气治疗. 治疗后对患者进行3年随访,评估UPPP对OSAHS合并CHF的疗效,以及对改善患者心功能的作用. 结果 研究共纳入OSAHS合并CHF病例32例,平均随访时间3. 07±0. 25年. 随访1年结果显示手术组AHI值较非手术治疗组显著降低(P<0. 01),而氧分压(PaO2)、氧饱和度(SaO2)较非手术组显著升高(P<0. 05). UPPP手术组左心室射血分数(LVEF)值较非手术治疗组明显增高(P<0. 05),而NYHA心功能分级较非手术治疗组明显降低(P<0. 05). 随访3年时,手术组较非手术治疗组AHI值、PaO2、SaO2 及NYHA心功能分级变化趋势同前,但LVEF值差异无统计学意义. 结论 UPPP治疗OSAHS合并CHF手术安全性良好,UPPP可显著改善患者通气状况,并可一定程度改善患者心功能.%Objective To evaluate the safety and efficiency of UPPP for OSAHS patients with CHF. And to clarify the improvement of cardiac function provided by UPPP. Methods According to inclusion and exclusion criteria, OSAHS patients with CHF under treat-ment in our hospital were enrolled in our study. They were divided into two groups, operation group and non-operation group. Patients in operation group received UPPP treatment, and non-operation group received drug therapy and continuous positive airway pressure thera-py. Then patients were followed up for 3 years after treatment. Results 32 OSAHS patients with CHF were enrolled in our study at last, with an average 3. 07±0. 25 years follow-up. One-year follow-up Results showed that operation group had a significantly lower AHI values than non-operation group (P < 0. 01),the partial pressure of oxygen (PaO2) and saturation of oxygen(SaO2)was outstanding higher (P < 0. 05), left ventricular ejection fraction (LVEF) values was remarkable higher (P < 0. 05), and NYHA classification was obviously lower (P < 0. 05). Three-years follow-up Results showed the same variation tendencies with 1-year Results , except LVEF had no statistical difference. Conclusion s UPPP was safe for OSAHS patients with CHF. It can significantly ameliorate the ventilative conditions, and probably improve cardiac function of those patients with CHF.
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