正压通气治疗对改良悬雍垂腭咽成形术后疗效的影响

目的 研究重度睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）患者行改良悬雍垂腭咽成形术（H-uvulopalato phargngoplasty,H-UPPP）术后短期应用持续正压通气（continuous positive airway pressure,CPAP）治疗对疗效的影响.方法 38例重度OSAHS患者分为两组,治疗组18例于手术后一周开始配戴CPAP治疗,平均应用34.3天.20例单纯行H-UPPP手术患者为对照组.两组患者于术后6个月行多导睡眠监测复查,并与术前进行比较.结果 治疗组及对照组术后6个月与术前PSG监测相比,AHI及夜间最低血氧饱和度明显改善（P＜0.001）;治疗组术后6个月与对照组术后6个月相比,夜间最低血氧饱和度明显升高（P＜0.001）,AHI之间的差异无显著性意义（P＞0.05）;睡眠结构中,治疗组的浅睡眠期和慢动眼睡眠期改变较对照组明显（P＜0.05）,而深睡眠期、觉醒指数及睡眠效率的改变无显著性意义（P＞0.05）.结论 改良UPPP术后行CPAP治疗可改善患者夜间低血氧的情况,使慢动眼睡眠期延长,减少浅睡眠期,对提高手术疗效有辅助作用.     

悬雍垂腭咽成形术后持续正压通气治疗

观察悬雍垂腭咽成形术（ｕｖｕｌｏｐｌａｔｏｐｈａｒｙｇｏｐｌａｓｔｙ,ＵＰＰＰ）后疗效不佳的阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）患者为手术组行持续正压通气（ｃｏｎｔｎｕｏｕｓｐｏｓｉｔｉｖｅａｉｒｗａｙｐｒｅｓｓｕｒｅ,ＣＰＡＰ）治疗的效果。方法１５例ＵＰＰＰ术后呼吸暂停低通气指数（ａｐｎｏｅａ－ｈｙｐｏｎｏｅａｉｎｄｅｘ,ＡＨＩ）仍大于     

传统及改良悬雍垂腭咽成形术对持续正压通气治疗的影响

目的　探讨传统悬雍垂腭咽成形术 (uvulopalatopharyngoplasty ,UPPP)及改良悬雍垂腭咽成形术后对阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapnea hypopneasyndrome ,OSAHS)患者持续正压通气 (continuouspositiveairwaypressure,CPAP)治疗的影响。方法　选择传统UPPP及改良UPPP的OSAHS患者分别为 2 4例和 42例 ,术后随访 1 2个月以上 ,比较两种术式的疗效 ,并对其中的2 4例传统UPPP和 1 5例改良UPPP术后患者进行睡眠状态下CPAP治疗压力耐受性测试。结果　术后 1年两种术式治疗OSAHS的有效率分别为 58 3 %和 61 9% ,差异无显著性。 2 4例传统UPPP患者术后有 4例 (1 6 7% )患者在CPAP治疗时产生严重的口腔漏气 ,不能耐受CPAP治疗 ;1 5例改良UPPP术后患者的CPAP压力耐受性与未行手术者相似。结论　OSAHS患者手术时应尽量保留悬雍垂 ,保留咽腔基本解剖结构 ,为下一步的CPAP治疗提供良好的基础     

悬雍垂腭咽成形术后持续正压通气治疗

目的观察悬雍垂腭咽成形术（ｕｖｕｌｏｐｌａｔｏｐｈａｒｙｇｏｐｌａｓｔｙ,ＵＰＰＰ）后疗效不佳的阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）患者为手术组行持续正压通气（ｃｏｎｔｉｎｕｏｕｓｐｏｓｉｔｉｖｅａｉｒｗａｙｐｒｅｓｕｒｅ,ＣＰＡＰ）治疗的效果。方法１５例ＵＰＰＰ术后呼吸暂停低通气指数（ａｐｎｏｅａｈｙｐｏｎｏｅａｉｎｄｅｘ,ＡＨＩ）仍大于２０的ＯＳＡＳ患者为手术组,随机选择３２例未经任何治疗的ＯＳＡＳ患者为对照组,均采用智能型持续正压通气机（ＡｕｔｏＣＰＡＰ）进行夜间治疗监测。对比两组患者行ＡｕｔｏＣＰＡＰ治疗的疗效,并分别对各组患者ＡｕｔｏＣＰＡＰ治疗效果进行分析。结果ＡｕｔｏＣＰＡＰ治疗模式下两组间呼吸暂停指数（ａｐｎｏｅａｉｎｄｅｘ,ＡＩ）、ＡＨＩ差异无显著性意义（Ｐ＞０．０５）,ＵＰＰＰ组最低血氧饱和度（ＬＳＯ２）高于对照组（Ｐ＜０．０１）。各组患者在ＡｕｔｏＣＰＡＰ诊断和治疗两种模式下的上述指标差异均有显著性意义（Ｐ均＜０．０１）。结论ＯＳＡＳ患者ＵＰＰＰ后疗效不佳者应用ＣＰＡＰ治疗仍有效,且不影响治疗效果。     

改良悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征89例分析

目的探讨改良悬雍垂腭咽成形术(H-uvulopalatopharyngoplasty,H-UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法对89例患者行H-UPPP治疗,摘除双侧扁桃体,切除腭帆间隙脂肪组织,完整保留悬雍垂。结果患者术后症状改善明显,无误呛及进食反流等症状,患者术前及术后12个月多导睡眠图(PSG)监测结果各指标比较,差异具有统计学意义。结论 H-UPPP疗效确切,可有效防止腭咽关闭不全等并发症。     

悬雍垂腭咽成形术中咽侧壁的成形

目的:探讨悬雍垂腭咽成形术(UPPP)中咽侧壁的成形方法。方法:治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)23例,采用以下方法处理咽侧壁:①保留腭舌弓。②松解腭咽弓与软腭交界处,将软腭游离缘的两端向前移位。③腭咽弓缘固定于扁桃体窝外侧壁,使腭咽弓黏膜面构成口咽腔光滑的外侧壁。观察手术的近、远期效果。结果:患者术后局部反应较轻,腭咽形态保持较好,随访1～5年,疗效满意。结论:咽侧壁的处理与成形是UPPP中的一个重要环节,重视对其处理可提高UPPP的疗效。     

改良腭咽成形术

目的改良腭咽成形术结合射频技术形成针对不同病态上气道形态的个性化术式。方法34例患者经多导睡眠监测(polysomnography,PSG)确诊为中或重度阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS);根据气道形态将传统腭咽成形术(uvulopalatopharyngoplasty,UPPP)改良为侧重扩大横径和扩大矢径两种术式,并选择性地进行局部射频消融。全部患者以治疗前后的PSG、咽腔测量数据及主观感觉等指标作对照。结果随访30例患者,术后6个月复查睡眠呼吸暂停低通气指数(apneahypopneaindex,AHI)值由54.7±18.2降至26.4±8.6(P﹤0.01),总有效率86.7%。结论改良腭咽成形术结合射频技术以气道形态改变为基础选择手术适应证,可明显提高疗效。     

扁桃体大小对悬雍垂腭咽成形术疗效的影响

目的：研究扁桃体大小对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者UPPP疗效的影响。方法：回顾性分析我科行UPPP手术的OSAHS患者54例,术后1年以上复查PSG确定疗效。结果：不同扁桃体大小组术前的各项指标（年龄、AHI、BMI、最低SpO2）;总体均数间差异无统计学意义（P〉0．05）,但术后各扁桃体组间疗效差异有统计学意义;扁桃体Ⅲ度患者最低SpO2提高明显;在重度OSAHS中,不同疗效组间的扁桃体大小构成差异有统计学意义。结论：扁桃体较大患者手术有效率较高,其最低SpO2也有显著改善;对于重度OSAHS亦应根据个体差异采取不同的治疗措施。     

改良悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征

目的改进传统的悬雍垂腭咽成形术（uvul opalatopharyngoplasty,UPPP）治疗阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）的疗效,探讨减少术后并发症的方法。方法对68例OSAHS患者行改良UPPP。手术要点：维持咽腔正常解剖生理形态,保留悬雍垂,切除腭帆间隙脂肪组织,对软腭和咽侧壁进行成形,充分扩大咽腔。术后随访6个月以上,12个月时行多道睡眠图（polysomnography,PSG）监测。结果患者憋气、打鼾、嗜睡等症状均于6个月内明显减轻或消失,术后12个月经PSG监测,其有效率为95.6%。结论改良UPPP可充分扩大咽腔空间,避免并发症,提高手术效果。     

保留三角皱襞的悬雍垂腭咽成形术36例分析

UPPP是治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的主要外科治疗方法,该术式一般需要术中切除双侧扁桃体,腭舌弓和腭咽弓拉拢缝合以扩大咽腔和减小创面,但是,扁桃体窝下部封闭的创面常在术后短期内裂开,导致腭舌弓黏膜撕裂、术后出血概率增加和局部瘢痕面积过大等不良后果.为解决扁桃体窝下部创面裂开的问题,我们尝试在UPPP中保留三角皱襞,以扩大黏膜覆盖面积和减低缝合时的张力,现报告如下.     

Outcomes of uvulopalatopharyngoplasty with harmonic scalpel after failure of continuous positive airway pressure in sleep apnea syndrome

The subjective visual horizontal (SVH) was measured by means of a small rotatable luminous line in darkness in the upright body position and at 10, 20 and 30° of body tilt to the right and left prior to, and during a follow-up period after, stapedotomy in 12 patients with otosclerosis. In the acute stage after surgery, SVH in the upright body position was significantly tilted away from the operated side. In addition, the perception of roll tilt towards the operated side (K_op) was significantly increased after stapedotomy, while the perception of roll tilt towards the healthy side (K_he) showed a slight but not significant reduction. After exclusion of two outliers, a statistically significant correlation was found between changes in K_op and in K_he. The slope of the regression line was 1.8 : 1, probably corresponding to a preference of the utricle for ipsilateral as opposed to contralateral head tilt. In four patients there was a weak (&;lt;1°/s) spontaneous nystagmus, not systematically related to the side of surgery, while in most cases there were no nystagmus or subjective vertigo symptoms. These specific changes in the subjective horizontal show that the otolithic effects on perception can be dissociated from canal effects. Further, the results are opposite to those for patients with unilateral loss of vestibular function. The tilt of SVH after stapedotomy indicates an increase in resting activity of utricular afferents. In addition, based on recent theories on otolith function, we suggest that an increased activity in saccular afferents is of major importance for the changes in roll-tilt perception because of its interaction with the utricle on the central nervous level.     

重度阻塞性睡眠呼吸暂停低通气综合征围手术期持续正压通气治疗

OBJECTIVE: (1) To investigate the severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients' perioperative variations of their polysomnographic indices, to discuss the necessity for their perioperative treatment; (2) To investigate the effects of continuous positive airway pressure (CPAP) on severe OSAHS patients during their perioperative period. METHODS: (1) 21 cases severe OSAHS patients were selected for at least 7 days preoperative CPAP therapy, and this group of patients were also given 3 continuous nights autotitrated CPAP (AutoSet) therapy postoperatively, i.e., the first 3 nights after operation. The 21 cases were remonitored with PSG during the second night after operation with their AutoSet ON. And all the 21 cases had revised uvulopalatopharygoplasty, in which the uvula is reserved completely. All patients apnea hypopnea index(AHI), lowest SaO2 (LSaO2), and sleep structure indices were calculated. (2) Another 24 cases of severe OSAHS patients without preoperative CPAP therapy or tracheotomy were selected as the control group, all patients received polysomnography (PSG) on the second night postoperatively. RESULTS: (1) 6 cases' condition of the control group got worse during the second night after operation, their LSaO2 are lower and their AHI got higher than pre-operation. For the another 18 cases, their condition got better than before operation. (2) 21 cases' AHI and LSaO2 are 61.1 +/- 9.9, 65.0% +/- 9.6% respectively before CPAP treatment, and the AHI and LSaO2 are 2.2 +/- 1.4, 94.5% +/- 2.9% during CPAP therapy. P < 0.001 (TTEST). All the 21 cases main symptoms disappeared after 1 week CPAP therapy. All 21 cases could tolerate AutoSet treatment well for the first 3 nights after operation. During the 2nd night with AutoSet therapy, the AHI and LSaO2 are 3.6 +/- 1.8 and 93.7% +/- 3.4% respectively. (3) For the 2nd night after operation, the CPAP and AutoSet treating group's AHI is lower than that of the control group, also the LSaO2 is higher, the deep and REM sleep stages are longer, and the S1, S2 sleep stages are shorter than that of the latter. CONCLUSION: For severe OSAHS patients, the postoperative condition has the possibility of getting worse. Perioperative CPAP therapy can have OSAHS patients severe condition alleviated, so the perioperative risks could be lowered; During the first 3 postoperative nights, AutoSet can be well tolerated by severe OSAHS patients.     

Adverse effects of continuous positive airway pressure therapy and its relation to the nose

The main problem in the treatment of obstructive sleep apnea syndrome (OSAS) with nasal continuous airway pressure (nCPAP) is the lack of compliance. One of the most important reasons for no compliance is the adverse effects of this treatment. We analyse, prospectively, 182 patients treated with nCPAP in order to show the relationship between previous nasal problems and adverse effects of nCPAP. Sixty percent of the population developed one o more side effects. Of this group, 69% showed nasal septum deviation at first examination in front of 31% that did not showed this problem (p = 0.001). In the group of patients with nasal side effects we observed an increase of compliance in 80% of patients treated medically and in 89% of those treated by a septoplasty. We demonstrate that the adverse effects of nCPAP are related to previous nasal problems and, also, that treatment of those problems can achieve an increase in compliance to nCPAP therapy.     

重度阻塞性睡眠呼吸暂停低通气综合征围手术期持续正压通气治疗

目的　观察重度阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapneahypopneasyndrome ,OSAHS)围手术期病情变化和持续正压通气治疗 (continuouspositiveairwaypressure,CPAP)的影响 ,探讨围手术期治疗的必要性。方法　 45例重度OSAHS患者均接受了完整保留悬雍垂的改良悬雍垂腭咽成形术。其中 2 4例不做围手术期CPAP治疗的作对照组 ,2 1例行围手术期CPAP治疗 :术前CPAP治疗 7d以上 ,于术后 1～ 3d夜应用自动调节治疗压力的CPAP(autotitratedCPAP ,AutoSet)进行治疗。治疗组患者术后第二夜在AutoSet治疗下同时做多导睡眠监测 (polysomnography,PSG)。对呼吸暂停低通气指数 (apneahyponeaindex ,AHI)、最低血氧饱和度 (lowestSaO2 ,LSaO2 )、血压以及睡眠结构等指标进行观察。结果　对照组 2 4例患者中有 6例于术后第二夜LSaO2 比术前下降 ,AHI升高 ,另外 1 8例患者LSaO2 升高 ,AHI下降。治疗组 2 1例患者CPAP治疗前AHI为 (61 1± 9 9)次 /h( x±s,以下同 ) ,LSaO2 为 65 0 %± 9 6 % ,手术前CPAP治疗后AHI为 (2 2± 1 4)次 /h ,LSaO2 为 94 5 %± 2 9% ,t检验P <0 0 0 1 ;手术前经CPAP治疗临床症状消失。术后患者均能良好耐受AutoSet治疗 ,术后第二夜应用AutoSet治疗时AHI为 (3 6± 1 8)次 /h     

Eustachian tube dysfunction in sleep apnea patients and improvements afforded by continuous positive airway pressure therapy

IntroductionUpper airway resistance may accompany eustachian dysfunction and alter middle ear pressure in patients with obstructive sleep apnea syndrome.ObjectiveTo investigate effects of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on eustachian tube functions.MethodsForty-two mild obstructive sleep apnea syndrome patients, 45 moderate obstructive sleep apnea syndrome patients, 47 severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy, 32 severe obstructive sleep apnea syndrome patients without continuous positive airway pressure therapy, and 88 individuals without sleep apnea (controls) were included. Tympanometric parameters of groups were compared.ResultsRight middle ear pressures in mild and moderate obstructive sleep apnea syndrome groups did not differ significantly from that of control group (p = 0.93 and p = 0.55), as was also true of the left middle ear pressures (p = 0.94 and p = 0.86). Right middle ear pressure was significantly higher in severe obstructive sleep apnea syndrome groups than in the control group, as was the left middle ear pressure (p < 0.001). Middle ear pressure (negative) was significantly lower in severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy compared to those without (p < 0.001). Right ear type B and C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (12.4%) than in the controls (0%) (p = 0.02). Left ear type B or C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (21.9%) than in the controls (0%) (p = 0.002).ConclusionMild and moderate obstructive sleep apnea syndrome did not affect middle ear pressure but severe obstructive sleep apnea syndrome may increase the (negative) middle ear pressure. In severe obstructive sleep apnea syndrome patients, long-term continuous positive airway pressure therapy may normalize middle ear pressure.     

Acoustic rhinometry predicts tolerance of nasal continuous positive airway pressure: a pilot study

BACKGROUND: Nasal continuous positive airway pressure (nCPAP) is usually the first-line intervention for obstructive sleep apnea, but up to 50% of patients are unable to tolerate therapy because of discomfort-usually nasal complaints. No factors have been definitively correlated with nCPAP tolerance, although nasal cross-sectional area has been correlated with the level of CPAP pressure, and nasal surgery improves nCPAP compliance. This study examined the relationship between nasal cross-sectional area and nCPAP tolerance. METHODS: We performed acoustic rhinometry on 34 obstructive sleep apnea patients at the time of the initial sleep study. Patients titrated to nCPAP were interviewed 18 months after starting therapy to determine CPAP tolerance. Demographic, polysomnographic, and nasal cross-sectional area data were compared between CPAP-tolerant and -intolerant patients. RESULTS: Between 13 tolerant and 12 intolerant patients, there were no significant differences in age, gender, body mass index, CPAP level, respiratory disturbance index, or subjective nasal obstruction. Cross-sectional area at the inferior turbinate differed significantly between the two groups (p = 0.03). This remained significant after multivariate analysis for possibly confounding variables. A cross-sectional area cutoff of 0.6 cm2 at the head of the inferior turbinate carried a sensitivity of 75% and specificity of 77% for CPAP intolerance in this patient group. CONCLUSION: Nasal airway obstruction correlated with CPAP tolerance, supporting an important role for the nose in CPAP, and providing a physiological basis for improved CPAP compliance after nasal surgery. Objective nasal evaluation, but not the subjective report of nasal obstruction, may be helpful in the management of these patients.     

上气道CT测量在持续气道正压通气治疗阻塞性睡眠呼吸暂停低通气综合征的意义

目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的上气道形态学与多道睡眠图监测和自动持续气道正压通气（auto-CPAP）治疗数据的相关性。方法选择2015年6～12月北京同仁医院收治的34例OSAHS患者,采用螺旋CT连续扫描,在硬腭水平、悬雍垂尖水平、舌根水平和会厌水平测量平静呼吸时各区前后径和左右径,并予auto-CPAP治疗,分析相关性。结果上气道最窄平面在悬雍垂尖水平。AHI与平均血氧饱和度（mean SaO2,MSaO2）（r=-0.724）、下颌骨下缘至舌骨下缘（r=-0.755）和硬腭水平左右径（r=-0.404）负相关;最低血氧饱和度（lowest SaO2,LSaO2）与MSaO2（r=0.624）、身高（r=0.501）正相关,与舌后隙左右径（r=-0.468）负相关;auto-CPAP 90%有效治疗压力与体质量指数（r=0.406）正相关,与LSaO2（r=-0.384）和硬腭水平左右径（r=-0.367）负相关。结论上气道CT对预测OSAHS患者病情严重程度和auto-CPAP治疗压力有参考价值,尤其是硬腭水平左右径的狭窄明显影响AHI和CPAP治疗压力。