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。     

朴次茅斯海军医学中心行悬雍垂腭咽成形术(UPPP)的经验

阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）是一种相当常见的疾病,一旦其暂停及呼吸紊乱指数（ＡＨＩ）大于５即可确诊。男性、肥胖、老年、颅面畸形及有家族ＯＳＡＳ史是患ＯＳＡＳ的危险因素。ＯＳＡＳ治疗包括气道正压通气疗法（ＣＰＡＰ）、矫形手术、气管切开术、激光辅助悬雍垂腭部成形术（ＬＡＵＰ）、悬雍垂腭咽成形术（ＵＰＰＰ）及各种正颌手术。其中ＵＰＰＰ适用于鼻咽或口咽部有解剖学阻塞的呼吸暂停患者。作者对１９９４年１月～１９９６年６月间行ＵＰＰＰ的医学纪录的病例进行了回顾性研究。把ＵＰＰＰ作为ＯＳＡＳ唯一治疗方法…     

激光辅助下的悬雍垂腭咽成形术(LAUP)在OSA中的疗效

当前阻塞性睡眠呼吸暂停（ＯＳＡ）的内科治疗包括双水平正压通气（ＢＩＰＡＰ）、持续正压通气（ＣＰＡＰ）、减肥、控制舌位装置和各种不同的牙矫正器等。ＯＳＡ的手术疗法包括悬雍垂腭咽成形术（ＵＰＰＰ）、鼻成形术、正颌手术等,尤以ＵＰＰＰ最常用。ＬＡＵＰ通过悬雍垂、软腭和腭弓再塑而扩大口咽通气道。与在手术室施行的ＵＰＰＰ相比,ＬＡＵＰ具有适用于不同的门诊病人、费用低、出血少且不出现腭咽关闭不全或狭窄的优点。为探讨ＬＡＵＰ治疗ＯＳＡ的疗效,作者对４８例患者施行了ＬＡＵＰ,患者均有打鼾、Ｍｕｌｌｅｒ'ｓ法示软…     

YAG激光腭咽成型术治疗阻塞性睡眠呼吸暂停综合征

阻塞性睡眠呼吸暂停综合征（Ｏｂｓｔｒｕｃｔｉｖｅ　 ｓｌｅｅｐ ａｐｎｅｓｓｙｎｄｒｏｍｅ, ＯＳＡＳ）表现为睡眠时因上呼吸道阻塞性病变引起打鼾、憋气和呼吸暂停。由于长时期反复发作,可因体内低氧血症和高碳酸血症,导致心、脑、肾、肺等重要器官损害,发生一系列并发症,少数重症者甚至发生夜间睡眠中猝死。 １９９１年开始．我们对因上气道,特别是咽部狭窄的ＯＳＡＳ患者．采用悬雍垂腭咽成型术（Ｕｖｕｌｏｐａｌａｔｏｐｈａｒｙｎｇ－ｏｐｌａｓｔｙ,ＵＰＰＰ）治疗,其中 ２１例手术用ＹＡＧ激光施行。现报道如下。资料…     

多导联睡眠监护仪对阻塞性睡眠呼吸暂停综合征检测的意义

报告阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）２４例及其中手术１６例的临床资料和用多导联睡眠描记法（ＰＳＧ）行手术前后７ｈ夜间检测，从ＰＳＧ５个项目１２种检测数据的分析，能了解鼾声的响度值，心率和心率失常，呼吸道阻塞程度与呼吸暂停时间及血氧饱和度，手术前后ＰＳＧ值的改变，说明了ＰＧＳ对诊断ＯＳＡＳ及检测手术及效果有一定价值，并提示悬雍垂腭咽成形术（ＵＰＰＰ）是治疗ＯＳＡＳ的有效手段。     

阻塞性睡眠呼吸暂停综合征腭咽成型术的远期疗效

阻塞性睡眠呼吸暂停综合征腭咽成型术的远期疗效张炎徐春晓姜鸿我院自１９８６年至１９９２年采用悬雍垂腭咽成形术（ｕｖｕｌｏｐａｌａｔｏｐｈａｒｙｇｏｐｌａｓｙ，ＵＰＰＰ）治疗阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｐａｐｎｅａｓｙｎｄｒｏ...     

阻塞性睡眠呼吸暂停综合征患者睡眠状态下阻塞定位

成人阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）发病率为２％～４％＾「１」,外科手术为ＯＳＡＳ的主要治疗方法,如悬雍垂腭咽成形术（ＵＰＰＰ）、矢状位下颌骨切开颏舌肌前移（ＩＳＯ）,舌成形术、上下颌骨前移等,其中ＵＰＰＰ手术应用最为广泛,但据大量文献报道ＵＰＰＰ手术有效率仅为５０％＾「２」,效果不佳的主要原因是多数患者的上呼吸道有多水平面的阻塞,因此对ＯＳＡＳ患者阻塞部位的确切定位对于治疗方案的选择具有重要     

UPPP与UPPP+TE的长期随访

悬雍垂腭咽成形术（ＵＰＰＰ）治疗阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）自１９８１年介绍以来,虽然在短期内获得疗效,但长期疗效研究甚少且无肯定的结果。作者通过对已接受ＵＰＰＰ治疗病人的打鼾、白天过度嗜睡和夜间去氧饱和指数（ＯＤＩ）的长期随访,来评价ＵＰＰＰ治疗ＯＳＡＳ病人的效果。５８例病人男５１例,女７例,年龄２９～７２岁,平均４９岁。所有的病人因打鼾或白天嗜睡而接受多导睡眠监测仪检测确诊为 ＯＳＡＳ,１９例单纯行ＵＰＰＰ手术,３９例行ＵＰＰＰ＋扁桃体切除（ＴＥ）。随访１１～７４个月,平均３４个月。…     

阻塞性睡眠呼吸暂停低通气综合征外科治疗的历史和现状

睡眠呼吸暂停综合征是睡眠呼吸疾患之一 ,自 2 0世纪70年代逐渐引起医学界的重视。从不同的视角看 ,有人把单纯性鼾症 (或原发性鼾症 ,ｓｎｏｒｉｎｇ) ,上气道阻力综合征(ｕｐｐｅｒａｉｒｗａｙｒｅｓｉｓｔａｎｃｅｓｙｎｄｒｏｍｅ ,ＵＡＲＳ)、阻塞性睡眠呼吸暂停低通气综合征 (ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａ ｈｙｐｏｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＨＳ)视为同一性质疾病的不同阶段。阻塞性睡眠呼吸暂停低通气综合征的手术治疗分为几类 ,包括上气道阻塞分流、软腭水平气道扩大和舌根水平气道扩大、鼻及鼻咽部阻塞性…     

阻塞性睡眠呼吸暂停综合征外科治疗疗效分析

自１９８７年，我院采用ＵＰＰＰ联合鼻部手术或单独行ＵＰＰＰ治疗阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）５９例，手术后随访０．５－８年，总有效率达８９．８％。本文对该病的手术治疗适应证和手术效果进行了讨论。     

阻塞性睡眠呼吸暂停程度与中性粒细胞／淋巴细胞比值的相关性研究

目的：探讨研究中性粒细胞／淋巴细胞比值（NLR）与阻塞性睡眠呼吸暂停综合征（OSAS）程度的关系。方法将158例按照睡眠期呼吸暂停低通气指数（AHI）情况分为4个组,分别为正常对照组（n ＝39）、轻度 OSAS组（n ＝38）、中度 OSAS 组（n ＝41）和重度 OSAS 组（n ＝40）,此外对重度 OSAS 组中的31例实施持续气道正压（CPAP）治疗3个月,对该31例进行 CPAP 治疗前后对比。比较的血细胞参数包括白细胞、中性粒细胞、淋巴细胞、中性粒细胞／淋巴细胞比值（NLR）。结果NLR 的组间比较显示重度 OSAS 组（3．29±1．19）显著高于正常对照组（1．71±0．69）、轻度 OSAS 组（1．70±0．71）,中度 OSAS 组较正常对照组和轻度 OSAS 组亦明显增高（均为P ＜0．05）,而正常对照组与轻度 OSAS 组间及中度 OSAS 组与重度 OSAS 组间差异无统计学意义（P ＞0．05）。重度 OSAS 患者 CPAP 治疗前后对比结果显示治疗后 NLR（1．98±0．81）较治疗前 NLR（3．28±0．62）显著降低（P ＜0．05）。此外4个组中 NLR 与睡眠期 AHI 是呈正相关的（r ＝0．758,P ＝0．034）,同时最低氧饱和度与 AHI呈负相关（r ＝－0．179,P ＝0．012）。结论NLR 可随着 OSAS 程度的加重而增高,因而可能作为一新的指标用来辅助评估 OSAS 患者体内炎症反应的严重程度。     

睡眠呼吸暂停综合征术前经鼻正压通气的治疗

OBJECTIVE: Preoperative nasal continuous positive airway pressure(NCPAP) treatment was used as a substitute for protective tracheostomy before UPPP surgery in 42 patients with severe obstructive sleep apnea syndrome(OSAS) from 1994 to 1996. METHODS: Fifty-two patients operated on three years before this period served as control group. All cases were diagnosed as severe OSAS by polysomnography (PSC). RESULTS: There were no statistical difference in main parameters between two groups. Seven cases in the control group underwent protective tracheostomy whose apnea and hypopnea index(AHI) was 28.4-83.5 and lowest saturation oxygen (SaO2) were 7%-32%. One patient underwent emergency tracheostomy due to life-threatening situation during uvulopalatopharyngoplasty (UPPP). There were 9 similarly severe cases who did not undergo protective tracheostomy in NCPAP treatment group. All patients underwent preoperative 5-20 day NCPAP treatment in treatment group. The average positive pressure was 1.16 kPa(11.85 cmH2O). There were significant difference in main parameters between the two groups. The AHI, SaO2 and sleep structure were evidently improved. UPPP was safely performed without protective tracheostomy and any complications in all patients with NCPAP treatment. CONCLUSION: This result implys that NCPAP treatment could be used as a substitute for protective tracheostomy before UPPP in severe OSAS.     

Tongue-base suspension in conjunction with uvulopalatopharyngoplasty for treatment of severe obstructive sleep apnea: long-term follow-up results

OBJECTIVES/HYPOTHESIS: To evaluate the usefulness of tongue-base suspension (TBS) in addition to uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Long-term prospective case series. SETTING: University tertiary care medical center. METHODS: Fifty-five consecutive patients with severe OSAS (apnea-hypopnea index [AHI] 52.8+/-14.9 events/hr) with multilevel upper airway obstruction who refused treatment with continuous positive airway pressure underwent UPPP plus TBS with the Repose system. All patients were evaluated before surgery by clinical history, Epworth Sleepiness Scale (ESS), fiberoptic nasopharyngoscopy with Müller maneuver, and nocturnal polysomnography (PSG). After 3 years of surgery, all patients were re-evaluated at the clinic and had ESS test and full PSG. Surgical success was defined when the ESS dropped bellow 11, and the AHI decreased below the threshold of 20 events per hour of sleep and at least 50% from the preoperative value RESULTS: There were 42 (78%) patients in which the AHI score decreased more than 50%, the AHI was lower than 20 events/hr in the PSG, and the ESS was lower than 11 after 3-years of follow-up (surgical success index). Logistic regression analysis demonstrated that body mass index at baseline was the only variable with significant statistical power to predict surgical success (odds ratio 0.85; 0.73-0.95, 95% confidence interval, P<.01) CONCLUSION: When associated with UPPP, the TBS technique performed with the Repose system demonstrates a surgical success of up to 78% for patients with severe OSA who refused nasal continuous positive airway pressure.     

Comparison of combined operation and nasal CPAP treatments for sleep disorders

Uvulopalatopharyngoplasty (UPPP) and nasal CPAP are used for the treatment of obstructive sleep apnea syndrome (OSAS) in different institutions. Although OSAS results from an abnormality in the soft-palate, almost no reports have been made on the selection of UPPP or nasal CPAP procedures according to the type of abnormality. The most probable reason for this is that a comparison of treatment methods in individuals cases is difficult. We performed CPAP titration before and after operations, and compared the treatment methods, and evaluated the medical therapy. METHOD: A sleep polygraph was performed on the first night, and cases diagnosed as OSAS received CPAP titration on the second night. The blocked region was identified by endoscopic examination. The results of the operation were evaluated after 1-2 months, and apnea hypopnea index (AHI) improvements of less than 50% received a second CPAP titration. RESULTS: The operation results were poor for cases where endoscopic examination showed full-circumference palatal type, and good for soft palate and tonsillar type abnormalities. When endoscopic examinations were performed in conjunction with nasal CPAP, the treatment was observed to act on the soft palate and expand the air way in all cases. Nasal CPAP was effective in cases with full-circumference palatal abnormalities because in these cases, the pressure was caused by inflamma. Combined medical treatments were effective in cases where CPAP alone was ineffective because the pressure was too high.     

阻塞性睡眠呼吸暂停综合征治疗模式的比较

目的 :分析比较阻塞性睡眠呼吸暂停综合征 (OSAS)不同治疗模式的疗效。方法 :将 5 2例患者分两组 :①单纯行悬雍垂腭咽成形术 (UPPP) (单纯UPPP组 ) 2 9例 ,②UPPP加经鼻持续正压通气 (CPAP)或口腔矫正器 (综合治疗组 ) 2 3例 ,进行治疗。结果 :两组近期疗效差异无显著性意义 (P >0 .0 5 ) ,但单纯UPPP组因术前未行CPAP治疗 ,故易出现手术并发症 ;两组远期疗效差异有极显著性意义 (P <0 .0 1)。结论 :OSAS采用多模式治疗是提高远期疗效的有效方法     

Combination therapy for severe sleep apnea syndrome

We assessed the treatment of severe SAS (sleep apnea syndrome) patients who had an AHI (apnea hypopnea index) over 100. Eleven (3.3%) of the 374 patients who came to our hospital between May 2002 and December 2003 had an AHI over 100. They received CPAP (continuous positive airway pressure) therapy as initial therapy, and the AHI recovered within normal limit in the five patients who did not have tonsillar hypertrophy. The other six patients had tonsillar hypertrophy, and the effect of CPAP was poor. Two of the six patients with tonsillar hypertrophy, underwent UPPP (uvuropalatopharyngoplasty), and CPAP become effective postoperatively. These results indicate that combined treatment by CPAP and surgery is an effective means of treating severe SAS with tonsillar hypertrophy.     

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(obstructive sleep apnea—hypopnea syndrome，OSAHS)患者持续正压通气(continuous positive airway pressure，CPAP)治疗的影响。方法 选择传统UPPP及改良UPPP的OSAHS患者分别为24例和42例，术后随访12个月以上，比较两种术式的疗效，并对其中的24例传统UPPP和15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。24例传统UPPP患者术后有4例(16．7％)患者在CPAP治疗时产生严重的口腔漏气，不能耐受CPAP治疗；15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。     

Surgical treatment of patients with severe obstructive sleep apnea syndrome

No standard indications currently exist for surgical treatment of severe obstructive sleep apnea syndrome (OSAS). We treated 15 patients with severe OSAS surgically, evaluated surgical indications, and evaluated surgical success. We retrospectively reviewed 15 cases of surgery for OSAS in which polysomnography met 2 or more criteria for the following surgical indications: (1) apnea hypopnea index (AHI) > or = 50, (2) minimum SpO2 below 80%, and (3) enlarged tonsils (grade III, Mackenzie's classification). Among the 15, mean AHI was 85.1. Surgery was done under general anesthesia, with uvulopalatopharyngoplasty (UPPP) in 13 and tonsillectomy alone in 2. Postoperative AHI was measured in 9 patients. According to Nishimura's criteria for assessing surgical success, improvement was "excellent" in 5, "good" in 1, "fair" in 1, and "poor" in 2. When we compared preoperative and postoperative use of continuous positive airway pressure (CPAP) in 7, we found that surgery decreased CPAP requirements. Surgical success was assessed in patients requiring CPAP and improvement was "excellent" in 5, "good" in 1, and "fair" in 1. In conclusion, surgical indications for severe OSAS, including the criterion of enlarged tonsils, were useful. Surgery decreased CPAP requirements and the degree of improvement in this requirement and AHI was valuable in assessing surgical success.     

短期持续正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征伴2型糖尿病患者胰岛素敏感性的影响

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴2型糖尿病患者行UPPP前,应用短期(7 d)持续正压通气(CPAP)治疗对其胰岛素敏感性的影响.方法:选择由PSG确诊的中、重度OSAHS伴2型糖尿病并需要行UPPP的患者30例,记录其AHI及夜间最低血氧饱和度(LSaO2),采用稳态模式评估(HOMA)指数评估胰岛素的敏感性,行7 d CPAP治疗后,复查PSG和计算HOMA指数,并与治疗前做比较.结果:经过7 dCPAP治疗后,AHI及LSaO2明显改善(P<0.05),胰岛素敏感性升高(P<0.05);AHI与空腹胰岛素水平呈正相关(r=0.636 5,P<0.05),与胰岛素敏感性呈负相关(r=-0.622 9,P<0.05);夜间LSaO2与空腹胰岛素水平呈负相关(r=0.8889,P<0.05),与胰岛素敏感性呈正相关(r=0.952 6,P<0.05).结论:短期CPAP治疗能改善OSAHS伴2型糖尿病患者夜间低血氧的情况,增加其胰岛素的敏感性,降低UPPP的危险性.     

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