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目的探讨改良UPPP联合鼻中隔偏曲矫正术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法回顾性分析多导睡眠监测仪监测确诊的33例中重度OSAHS患者,电子鼻咽镜和上气道CT确定阻塞平面位于鼻和腭咽平面,均行同期改良UPPP联合鼻中隔偏曲矫正术,术前先行经鼻持续气道正压通气治疗1周。6～12个月后复查多导睡眠监测。结果所有患者无围手术期并发症,术后鼾声响度及ESS评分较术前明显改善。按照2009年OSAHS诊断依据和疗效评定标准,治愈4例,显效20例,有效9例。呼吸暂停低通气指数(apnea hyponea index,AHI)由术前41.8次/时(25.1～63.4次/时)下降为18.2次/时(3.7～36.5次/时),最低血氧饱和度及血氧饱和度低于0.90的时间占总睡眠时间百分比分别由术前0.76(0.41～0.85)和14.0%(6.1%～28.2%)改善至0.87(0.76～0.94)和2.5%(0.1%～7.2%)。结论改良UPPP联合鼻中隔偏曲矫正术治疗阻塞性睡眠呼吸暂停低通气综合征可取得良好效果,术前行持续气道正压治疗能有效预防手术并发症的发生。
Objective To investigate the effect of modified UPPP plus nasal septum deviation correction on obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Retrospective analysis of 33 cases of moderate and severe OSAHS diagnosed by polysomnography was retrospectively analyzed. Electron-nasopharyngoscopy and upper airway CT were performed to determine the obstruction plane in the nasal and velopharyngeal planes. All patients underwent simultaneous UPPP and nasal septum deviation correction. Preoperative nasal continuous positive airway pressure treatment for 1 week. After 6 to 12 months to review polysomnography. Results All patients had no perioperative complications, postoperative snoring loudness and ESS score improved significantly compared with that before operation. According to the 2009 OSAHS diagnostic criteria and efficacy evaluation criteria, 4 cases were cured, markedly effective in 20 cases and effective in 9 cases. The apnea hyponea index (AHI) decreased from 41.8 beats / hour (25.1 to 63.4 beats / hour) to 18.2 beats / hour (3.7 to 36.5 beats / hours) before operation, with the lowest oxygen saturation and oxygenation The percentage of total sleep less than 0.90 was improved from 0.76 (0.41 ~ 0.85) and 14.0% (6.1% ~ 28.2%) to 0.87 (0.76 ~ 0.94) and 2.5% (0.1% ~ 7.2% . Conclusion Modified UPPP combined nasal septum deviation correction of obstructive sleep apnea-hypopnea syndrome can achieve good results. Preoperative continuous positive airway pressure therapy can effectively prevent the occurrence of surgical complications.