量表衡量悬雍垂腭咽成形术后患者生活质量

目的探讨悬雍垂腭咽成形术对阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)患者生活质量的影响。方法选择40例行悬雍垂腭咽成形术的OSAHS患者,采用Calgary生活质量指数(SAQLI)在术前及术后3个月进行问卷调查,从量表中的日常活动、社会活动、情感及症状4个方面比较与健康相关的生活质量,各部分的平均分相加即为量表的总分。结果40例OSAHS患者SAQLI总分从术前4.0±0.9提高至术后4.8±1.1(P<0.05),具有显著性的统计学意义,其中以日常活动、症状方面改善更为明显。结论悬雍垂腭咽成形术可有效地提高OSAHS患者与健康相关的生活质量。     

改良保留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疗效分析

目的探讨改良保留悬雍垂腭咽成形术治疗因软腭肥厚导致阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的手术方法及疗效。方法2013年4月~2014年4月对65例软腭肥厚腭咽平面狭窄的中重度OSAHS患者行软腭正中切开联合改良保留悬雍垂腭咽成形术,术前及术后行上气道CT等相关检查,分析65例患者手术后的疗效及各参数的变化情况。结果65例患者手术后1年呼吸暂停低通气指数(AHI)由(42.58±5.66)次/h降低至(15.26±3.39)次/h,差异具有统计学意义(P<0.01);最低血氧饱和度由0.743±0.063提高至0.8613±0.053,差异具有统计学意义(P<0.01);Epworth嗜睡量表4个指标均较术前有明显改善(P<0.01)。65例患者中治愈31例(47.7％),显效30例(46.2％),有效3例(4.6％),无效1例(1.5％)。3例患者术后3个月有轻微吞咽障碍及咽痛,2例患者术后7 d出现扁桃体窝出血,局部压迫后止血。结论改良保留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术式相对简单,主观疗效较好,且并发症较少,临床可选择性采用。     

悬雍垂腭咽成形加舌根射频消融联合手术的临床应用

目的探讨悬雍垂腭咽成形术加舌根射频消融联合治疗重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrom e,OSAHS)的疗效。方法对46例重度有腭咽和舌根平面阻塞的OSAHS的患者分两组,第一组22例(2000年8月至2002年8月)行单纯保留悬雍垂腭咽成形术,第二组24例(2002年9月至2004年8月)行保留悬雍垂腭咽成形术加舌根射频消融术。患者进行手术前后口咽腔的测量,并行睡眠监测。结果46例OSAHS患者手术后腭舌弓间距和腭咽弓间距变宽、软腭长度缩短,差异有统计学意义(P<0.001),而咽部后气道宽度(pharyngealposterior airway w idth,PPAW)在第一组没有变化,在第二组变宽,两组比较差异有统计学意义(P<0.001)。第一组患者术前睡眠呼吸暂停低通气指数(apnea hypopnea index,AH I)平均(56.5±6.0)次/h(x-±s,以下同),最低血氧饱和度(lowest SaO2,LSaO2)为0.626±0.060,术后AH I为(23.7±2.7)次/h,LSaO2(0.797±0.053);第二组术前AH I(58.4±5.1)次/h,LSaO2为0.650±0.057,术后AH I为(15.5±3.2)次/h,LSaO2为0.864±0.064。AH I、LSaO2两组术后均明显改善,差异有统计学意义(P<0.001),按照杭州会议疗效评定标准第一组有效率为72.7%(16/22),第二组有效率为87.5%(21/24)。第一组和第二组疗效相比差异也有统计学意义(R id it分析u=2.178,P<0.05)。结论对阻塞性睡眠呼吸暂停低通气综合征的患者,明确多平面阻塞,应进行联合治疗,保留悬雍垂腭咽成形加舌根射频消融术联合治疗可达到较好的疗效。     

全长保留悬雍垂腭咽成形术后口咽腔解剖径线变化观察

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)行全长保留悬雍垂腭咽成形术后远期的口咽腔解剖径线的变化。方法:对31例行全长保留悬雍垂腭咽成形术后的OSAHS患者进行随访,并且根据其手术前后口咽腔测量结果进行比较分析,包括:悬雍垂长、悬雍垂基底宽、腭舌弓间距和腭咽弓间距、软腭长度、悬雍垂至咽后壁的间距,此外还有颈围和体质指数。结果:OSAHS患者术后与术前相比较,悬雍垂的长与悬雍垂的基底宽、两侧腭弓(腭咽弓或腭舌弓)间距、软腭的长度、悬雍垂至咽后壁的距离均差异有统计学意义(均P<0.05),而颈围及体质指数均差异无统计学意义(均P>0.05)。结论:全长保留悬雍垂腭咽成形术是解决上气道狭窄,尤其是口咽部狭窄的有效手术方法,可以扩大患者口咽部左右径达到健康人水平。     

阻塞性睡眠呼吸暂停低通气综合征与促红细胞生成素相关性研究

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清促红细胞生成素(EPO)水平及与UPPP的疗效的相关性.方法:59例OSAHS患者行UPPP,测量咽腔术前术后改变;测定OSAHS患者术前、术后及38例对照组的血清EPO水平;观察各测量值的变化.结果:OSAHS患者手术前后颈围、AHI、SaO2、BMI、腭舌弓间距、悬雍垂与咽后壁间距、软腭长度、悬雍垂长度、口咽部最小截面积比较均差异有统计学意义(均P＜0.01);术前上述测值与对照组比较均差异有统计学意义(均P＜0.01),术后颈围、BMI、口咽部最小截面积与对照组比较均差异有统计学意义(均P＜0.05),而腭舌弓间距、悬雍垂与咽后壁间距、软腭长度、悬雍垂长度与对照组比较均差异无统计学意义(均P＞0.05).OSAHS患者EPO水平手术前后比较差异有统计学意义(P＜0.01);后与对照组比较EPO水平差异无统计学意义(P＞0.05).结论:OSAHS患者血清EPO水平较对照组偏高,并与睡眠呼吸暂停的程度有关.UPPP是有效的OSAHS治疗手段,治疗有效者血清EPO水平降低.     

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。     

射频等离子悬雍垂腭咽成形术疗效观察

目的:探讨腭咽射频等离子成形术治疗腭咽平面阻塞所致的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法:将81例以腭咽平面阻塞所致的OSAHS患者分成两组,分别进行UPPP和腭咽射频等离子成形术。结果:术后6个月随访,两组疗效相当。结论:悬雍垂腭咽射频等离子成形术时间短、出血少、安全、术后疗效满意。     

阻塞性睡眠呼吸暂停低通气综合征和肥胖及正常体重人群血清瘦素水平的研究

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)、肥胖和正常体重人群的血清瘦素水平。方法:将经PSG检测的患者分为OSAHS组(53例)和单纯肥胖组(41例),另选正常体重者(正常体重组)62例,用放射免疫法测定3组的血清瘦素水平,同时测量每例受检者的身高、体重、颈围、腰围和臀围。结果:①无论男性还是女性,OSAHS组和单纯肥胖组的血清瘦素水平均比正常体重组高(均P<0.05);OSAHS组血清瘦素水平[男(8.06±2.58)μg/L,女(12.83±2.67μg/L)]均高于单纯肥胖组[男(5.75±1.27)μg/L,女(9.83±1.99μg/L)](均P<0.05)。②单纯肥胖组及OSAHS组血清瘦素水平分别与体质指数(BMI)呈显著正相关(均P<0.01),OSAHS组血清瘦素水平与AHI、颈围及腰臀围比(WHR)也呈显著正相关(均P<0.01)。结论:单纯性肥胖患者血清瘦素水平升高与机体内发生瘦素抵抗有关;OSAHS患者的血清瘦素水平与AHI呈正相关,说明OSAHS本身可能是引起血清瘦素升高的因素之一,瘦素可能有兴奋呼吸中枢的作用。     

保留悬雍垂的腭咽微波成形术的临床疗效观察

目的：探讨腭咽微波成形术治疗腭咽平面阻塞所致的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的治疗效果。方法：对61例腭咽平面阻塞所致的OSAHS患者进行腭咽微波成形术,其中9例单纯行腭咽微波成形术,36例加双侧腭扁桃体切除术。16例加双侧腭扁桃体切除术及舌根微波消融术。结果：悬雍垂术后约2周开始回缩,约3个月接近或达到正常水平,保留咽腔的基本形态结构。无一例出现腭咽关闭不全。21例术后有咽部异物感,持续2～5个月渐消失。6个月后随访,治愈13例(21．31％),显效32例(52．46％),有效12例(19．67％),无效4例(6．56％),总有效率93．44％。结论：悬雍垂腭咽微波成形术手术时间短、出血少．术后效果满意。     

改良悬雍垂腭咽成形术长期疗效的主观评价

目的 评价保留悬雍垂的改良悬雍垂腭咽成形术(Han-uvulopalatopharyngoplasty,H-UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者术后5年的主观疗效改善程度.方法 回顾性队列研究.电话问卷随访2165例确诊5年及以上的OSAHS患者(呼吸暂停低通气指数≥5次/h),分为未治疗组、...     

阻塞性睡眠呼吸暂停低通气综合征患者的血浆食欲素A水平测定及意义

目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血浆食欲素A水平以及手术治疗对血浆食欲素A水平的影响。方法：对54例经PSG确诊的重度OSAHS患者（OSAHS组）行UPPP加舌骨悬吊术,另选择20例年龄、性别、BMI等均相匹配的健康者作为对照（对照组）。采用层析及放射免疫测定法,测定OSAHS患者术前、术后6个月血浆食欲素A水平,分析其与AHI、MAI及最低SaO2的关系及术前、术后血浆食欲素A水平的变化。结果：OSAHS组血浆食欲素A水平显著高于对照组（P〈0．01）,且与AHI、MAI呈正相关（r=0．658,0．464,均P〈0．05）,与最低SaO2呈负相关（r=-0．543,P〈0．01）,54例OSAHS患者术后6个月血浆食欲素A水平明显低于术前（P〈0.01）,且这种差异与BMI无关。结论：OSAHS患者血浆食欲素A水平升高,其原因可能与夜间反复多发作呼吸暂停及低氧血症有关,有效的手术治疗可使血浆食欲素A水平下降。     

阻塞性睡眠呼吸暂停低通气综合征合并高血压患者睡眠结构分析及血清内皮素-1的测定

OBJECTIVE: To explore the role of endothelin-1 (ET-1) in the pathogenesis of hypertension in obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: The levels of serum ET-1 in 30 OSAHS patients accompanied by hypertension, 30 normotensive OSAHS patients and 30 healthy controls were measured by ET-1 enzyme immunoassay kit. Meanwhile the correlation about the concentration of ET-1 in OSAHS patients with the clinic, polysomnography (PSG) parameters was analyzed. RESULTS: OSAHS patients with or without hypertension compared with snoring group and normal people, the sleep structure was significantly disturbed. The time percentages of awake and stage I sleep were increased, while stage II sleep decreased significantly in OSAHS patients than those in snoring group (P < 0.01, respectively). There were no significantly difference about the sleep structure in the two OSAHS groups. The levels of serum ET-1 (mean +/- s) were significantly higher in OSAHS patients accompanied by hypertension and normotensive OSAHS patients(42.5 +/- 8.4) ng/L and (38.6 +/- 4.7) ng/L respectively than those in the healthy controls(33.1 +/- 5.4) ng/L (P < 0.01, respectively). In the two OSAHS groups, the levels of serum ET-1 were significantly higher in OSAHS patients accompanied by hypertension than those in the normotensive OSAHS patients (P < 0.05). There were positive correlations between the concentration of ET-1 and the apnea hypopnea index (AHI) in all the 60 OSAHS patients with and without hypertension (r = 0.334, P < 0.01). There were negative correlations between the concentration of ET-1 and the lowest oxygen desaturation in all the 60 OSAHS patients with and without hypertension (r = -0.230, P < 0.05). CONCLUSION: These results indicate that the sleep disordered breathing and hypoxia may contribute to the elevation of ET-1 in the OSAHS patients and OSAHS patients accompanied by hypertension. ET-1 may play an important role in the pathogenesis of OSAHS-induced hypertension.     

儿童阻塞性睡眠呼吸暂停低通气综合征对抗利尿激素水平的影响

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)对体内抗利尿激素(antidiuretic hormone,ADH)分泌水平的影响.方法 30例确诊为OSAHS的患儿分别于扁桃体+腺样体切除术前和术后行多道睡眠监测,在深睡期取静脉血采用放射免疫技术检测患儿血浆中ADH水平并记录夜间12 h尿量,与20例健康儿童夜间深睡期ADH水平和12 h夜尿量进行比较分析.结果 OSAHS患儿呼吸暂停低通气指数术后2个月由术前(17.4±2.6)次/h(-x±s,下同)下降至(3.3±1.4)次/h,最低动脉血氧饱和度由0.783±0.134上升至0.954±0.062,差异有统计学意义(t值分别为27.68和6.45,P值均＜0.001).OSAHS患儿夜间血浆ADH水平为(63.1±35.2)ng/L,明显低于健康儿童的(85.1±22.2)ng/L,夜尿量(492±90)ml显著高于健康儿童(346±62)ml,差异有统计学意义(t值分别为2.75和6.43,P值均＜0.01);治疗后ADH达(83.1±21.2)ng/L,较术前明显上升(t=2.56,P＜0.05),夜尿量(332±56)ml较术前明显下降(t=7.85,P＜0.001),与健康儿童相比差异均无统计学意义(t值分别为0.17和0.77,P值均＞0.05).结论 OSAHS患儿可能因夜间ADH水平下降导致夜尿增多,解除呼吸道梗阻使患儿睡眠恢复正常,可能促使ADH水平趋于正常,夜间尿量减少.     

觉醒在儿童阻塞性睡眠呼吸暂停低通气综合征中的变化与意义

目的：探讨觉醒在儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）中的变化与意义。方法：采用32导PSG监测仪，Polysmith睡眠分析软件，按国际通用标准导联连接方法，对48例睡眠呼吸障碍儿童进行整夜监测。按国际通用标准，对比分析OSAHS患儿（OSAHS组）与单纯打鼾儿童（单纯打鼾组）的觉醒变化。结果：OSAHS组的学龄前亚组和学龄期亚组非快速眼动期（NREM）1、2、3期加4期和快速眼动期（REM）几项指标，分别与单纯打鼾组的学龄前亚组和学龄期亚组比较，差异均无统计学意义（均P〉0．05）；而伴AHI觉醒指数（ArI）、伴腿动（LM）的ArI和总ArI指数OSAHS组的学龄前亚组均明显高于单纯打鼾组的学龄前亚组（均P〈0．05）；而伴鼾声ArI、自发性ArI分别与单纯打鼾组的学龄前亚组和学龄期亚组比较，差异均无统计学意义（均P〉O．05）。结论：OSAHS组患儿的睡眠为不安定睡眠，这种睡眠虽未造成睡眠结构的改变，但引起伴AHI的ArI、伴LM的ArI与总ArI数量的增加。     

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.     

睡眠呼吸紊乱儿童腺样体中糖皮质激素受体的表达

目的 了解阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)儿童腺样体组织中糖皮质激素受体(glucocorticoid receptor,GR)亚型mRNA表达.方法 34例儿童行腺样体切除,术前睡眠监测;应用荧光定量逆转录PCR法检测患者腺样体组织中GR-α和GR-β mRNA的表达.结果 腺样体组织中均存在GR-α和GR-β的mRNA表达,且GR-αmRNA呈高表达.OSAHS患儿(22例)腺样体组织中的GR-α和GR-β mRNA(-x±s,以下同)分别为(9.40±3.06)×105cDNA copies/μg和(1.57±0.35)×104 cDNA copies/μg;非OSAHS患儿(12例)腺样体组织中的GR-α和GR-β mRNA分别为(1.60±0.26)×106cDNA copies/μg和(1.52±0.18)×104cDNA copies/μg.非OSAHS患儿腺样体组织中的GR-α mRNA较OSAHS患儿腺样体组织中的GR-α mRNA增高(F=40.285,P＜0.001);OSAHS患儿腺样体组织中的GR-β mRNA较非OSAHS患儿腺样体组织中的GR-β mRNA稍高,但差异无统计学意义(F=0.145,P=0.706).OSAHS、非OSAHS腺样体组织中GR-α/GR-β比值分别为62.3±20.3和107.4±24.4,差异有统计学意义(F=33.059,P＜0.001).结论 OSAHS儿童腺样体组织中存在糖皮质激素受体亚型表达,非OSAHS儿童腺样体对糖皮质激素可能比OSAHS儿童更敏感.GR在儿童OSAHS中的作用有待进一步研究.     

阻塞性睡眠呼吸暂停低通气综合征患者血清NO和oxLDL水平的变化及临床意义

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清中NO、氧化低密度脂蛋白(oxLDL)水平的变化及两者的相关性。方法:测定60例OSAHS患者和26例健康体检者血清中NO和oxLDL水平的变化;根据AHI将OSAHS患者分为轻度、中度、重度3组。结果:中、重度组患者血清NO水平明显低于对照组,oxLDL水平高于对照组,均差异有统计学意义(均P<0.05)。OSAHS患者血清NO与AHI、oxLDL均呈负相关(P<0.01),与夜间最低血氧饱和度呈正相关(P<0.01);oxLDL与AHI呈正相关(P<0.01),与夜间最低血氧饱和度呈负相关(P<0.01)。结论:中、重度OSAHS患者血清NO水平随着AHI的增加和缺氧程度的加重而降低,oxLDL水平则随AHI的增加和缺氧程度的加重而升高,表明OSAHS患者血管内皮功能失调与夜间缺氧程度密切相关,NO浓度的降低和oxLDL水平的升高进一步促进了动脉粥样硬化的形成,增加了OSAHS患者心脑血管事件发生的危险性。