加速康复外科在阻塞性睡眠呼吸暂停综合征患者同期多平面手术围手术期的应用价值研究

目的 探讨加速康复外科(enhance recovery after surgery,ERAS)理念在阻塞性睡眠呼吸暂停综合征(OSAS)同期多平面手术围手术期的应用价值.方法 选取2019年11月～2020年7月就诊行两个或两个以上多平面手术的OSAS患者45例,随机分ERAS组(n=22)和对照组(n=23),分别...     

阻塞性睡眠呼吸暂停综合征动物模型的建立方法

阻塞性睡眠呼吸暂停综合征(OSAS)因其高发病率和对人体多个系统的严重危害,已成为近年来多学科研究的热点。英格兰牛头犬(Englishbulldog)〔1〕、中国广西陆川猪〔2〕及最近发现的新西兰肥胖的(New Zealand obese)小鼠〔3〕这些自发性OSAS动物模型由于来源相对困难,不可能大量应     

阻塞性睡眠呼吸暂停与肿瘤相关性进展

阻塞性睡眠呼吸暂停(OSA)作为一种世界流行的慢性疾病,近年来其发生率逐年增加。OSA的主要特点是上气道反复塌陷,由此引起反复的呼吸暂停、低通气和频繁血氧饱和度下降,进而引发睡眠片段化、睡眠结构紊乱,患者通常伴有白天嗜睡、注意力不集中等。长期的睡眠片段化和微觉醒状态与许多慢性疾病结局相关,比如高血压、心肌梗死、2型糖尿病、阿尔兹海默病等。另外,OSA还与肿瘤密切相关。随着OSA和低氧血症严重程度的增加,相关的多种肿瘤的发生率与死亡率也增加,如肺癌、乳腺癌、鼻咽癌、前列腺癌、中枢神经系统的肿瘤等。论文对阻塞性睡眠呼吸暂停的概况、与肿瘤相关的统计学证据进行综述,并讨论了OSA与肿瘤相关的分子机制、治疗等方面的内容,旨在为阻塞性睡眠呼吸暂停与肿瘤的相关研究及临床实践提供参考依据,为进一步研究治疗方法提供新思路。     

阻塞性睡眠呼吸暂停综合征患者上气道的形态？…

目的 应用计算机辅助纤维喉镜检查结合Ｍｕｅｌｌｅｒ检查法（ｃｏｍｐｕｔｅｒ ａｓｓｉｓｔｉｎｇ ｆｉｂｅｒｏｐｔｉｃ ｐｈａｒｙｎｇｏｓｃｏｐｙ ｗｉｔｈ ｍｕｅｌｌｅｒ’ｓｍａｎｅｕｖｅｒ,ＣＦＰＭＭ）研究阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅ ｓｌｅｅｐ ａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）上气道形态异常,探讨该方法在ＯＳＡＳ定位诊断中的应用价值。方法 ＣＦＰＭＭ观察ＯＳＡＳ患者及     

外科治疗成人阻塞性睡眠呼吸暂停低通气综合征

阻塞性睡眠呼吸暂停低通气综合征是一种以睡眠时出现反复性和间歇性上呼吸道软组织塌陷为特征的睡眠呼吸障碍疾病。各种因素导致上呼吸道阻塞是阻塞性睡眠呼吸暂停低通气综合征的重要致病因素,因此针对不同平面阻塞的上气道重建手术不仅改善气道通气截面积,而且改善患者打鼾、睡眠结构紊乱等临床症状,降低了心脑血管疾病发病风险,从而提高了患者的临床疗效。     

上气道压力测定在阻塞性睡眠呼吸暂停低通气综合征诊治中的应用

目的:利用压力测定法在上呼吸道内更直接地了解发生睡眠呼吸暂停低通气事件时上气道的动态变化.方法:经PSG确诊为阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的21例患者行ApneaGraph上气道压力测定,获得不同体位时的呼吸紊乱指标、判定阻塞平面及各平面阻塞出现的频率.结果:①21例患者不同体位时平均发生的异常呼吸事件AHI:仰卧睡眠时AHI为(47.83±18.05)次/h,侧卧位AHI为(35.11±18.88)次/h,两者差异有统计学意义(P<0.05),②阻塞平面以软腭悬雍垂以上部位(成人主要是腭后区)为主,占异常呼吸事件的84.48%;软腭悬雍垂以下部位(舌后区为主)占异常呼吸事件的12.58%.结论:通过上气道压力测定,可较好地判断睡眠时患者气道阻塞部位,压力测定装置还可作为便携PSG,对OSAHS作出初步定性诊断,为治疗方案的选择提供了有参考价值的资料.     

远程睡眠医疗在阻塞性睡眠呼吸暂停低通气综合征中的应用

远程睡眠医疗是通过电子通信技术在不同地域站点间交换睡眠医学相关信息,促进患者健康的新型医疗模式,已广泛应用于失眠及白天嗜睡的患者,在阻塞性睡眠呼吸暂停低通气综合征患者中的应用已逐步开展,包括疾病监测、诊断治疗、健康教育及随访等方面,显示出良好的应用前景,在保证疗效的基础上补充患者就诊方式,减轻医疗负担。本文就远程睡眠医疗在阻塞性睡眠呼吸暂停低通气综合征中的应用现状进行综述。     

射频在治疗阻塞性睡眠呼吸暂停综合征中的应用

文章介绍了射频治疗的原理，此项治疗在耳鼻咽喉科的应用和相关动物实验，与激光治疗相比较，认为射频治疗对OSAS有一定发展前景。     

便携式睡眠监测阻塞定位仪在睡眠呼吸暂停综合征诊断中的应用

目的研究便携式睡眠监测阻塞定位仪(ApneaGraph,AG 200)在睡眠呼吸暂停综合征(OSAS)诊断中的临床应用价值。方法 33例睡眠打鼾患者,采用ApneaGraph进行整夜睡眠呼吸监测,分析呼吸紊乱指标、出现呼吸暂停低通气事件时的阻塞平面,不同平面的阻塞次数和总阻塞次数,阻塞性呼吸暂停平均P0-P0峰值与呼吸暂停低通气指数(AHI)的相关性。结果①33例睡眠打鼾患者均很好耐受整夜AG 200监测。②33例患者中有30例被诊断为OSAS,其中轻度6例、中度10例、重度14例,有3例被排除。③1例上部阻塞为100%,32例为上部和下部联合阻塞,但多以上部阻塞为主。④阻塞性呼吸暂停平均P0-P0峰值与AHI正相关(r=0.78,t=6.94,P=0.000)。结论 ApneaGraph对OSAS的诊断具有临床价值。     

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。     

加速康复外科在儿童OSAS围手术期中的应用

目的 探讨加速康复外科(ERAS)在阻塞性睡眠呼吸暂停综合征(OSAS)患儿围手术期中的应用效果。 方法 将鼻内镜下腺样体消融+双侧扁桃体切除术的1 968例患儿,随机分为ERAS组1 040例和传统组928例,ERAS组于ERAS模式下进行围手术期处理,传统组进行传统的围手术期处理。比较术后住院时间、并发症发生率、两组疼痛评分、精神状态与术后饮食量。 结果 传统组、ERAS组术后住院时间分别为(3.5±1.2)、(2.3±0.8)d,两组比较(t=-5.529, P=0.001)。传统组、ERAS组并发症发生率分别为1.29%(12/928)、0.19%(2/1040)(χ2=8.413, P=0.004)。传统组围手术期处理术后2 、12和24 h痛觉评分分别为(2.42±0.89)、(3.40±0.82)、(3.12±0.62)分,ERAS组分别为(1.69±0.58)、(2.32±0.69)、(2.13±0.42)分,差异均有统计学意义(P均< 0.01)。传统组术后6、12和24 h精神状态评分分别为(5.42±0.89)、(3.40±0.82)、(3.12±0.75)分,ERAS组分别为(3.36±0.57)、(2.55±0.50)、(1.65±0.45)分,差异均有统计学意义(P均<0.01)。传统组术后6、12和24 h冷流质饮食量分别为(2.0±1.2)、(16.5±2.6)、(24.0±13.0)(mL/kg), ERAS组术后6、12和24 h冷流质饮食量分别为(5.0±1.8)、(26.5±5.8)、(68±26)(mL/kg),差异均有统计学意义(P均< 0.01)。 结论 ERAS用于OSAS患儿围手术期效果确切。     

Mood improvement after surgery for obstructive sleep apnea

OBJECTIVE: Patients with obstructive sleep apnea (OSA) may experience unfavorable psychologic symptoms such as depression and anxiety. The aim of this study was to confirm this hypothesis and to investigate whether the psychologic symptoms among OSA patients can be relieved by surgical intervention. STUDY DESIGN: Prospective, longitudinal intervention study. METHODS: The 5-Item Mental Health scale (MH-5) was used to evaluate the postoperative changes of mood after extended uvulopalatal flap (EUPF) surgery on 84 Taiwanese patients with OSA. The preoperative and postoperative MH-5 data obtained from these patients were compared with a Taiwanese population norm. RESULTS: Before surgery, the MH-5 scores of the OSA patients were significantly worse than the Taiwanese population norm of 72.8 (P <.0001). Postoperatively, mean MH-5 scores significantly increased from 61.8 +/- 16.0 to 70.0 +/- 15.8 (P =.0006). The effect size of this score change was 0.51, indicating a moderate degree of mood improvement. However, this score was still inferior to that of the population norm (P =.0045). The mood improvement was not significantly associated with the changes in either sleep apnea events or the level of sleepiness. Neither the changes in respiratory disturbance index (P =.4382), maximum arterial oxygen saturation (P =.4866), nor the change in Epworth Sleepiness Scale scores (P =.4951) were predictive of the MH-5 score improvement (R = 0.07). CONCLUSIONS: This study demonstrated that patients with OSA had a higher level of anxiety, depression, and probable behavior or personality changes than the population norm. EUPF surgery could significantly improve the mood status among OSA patients; the effect of surgery was mild but clinically relevant. However, the extent of mood improvement experienced by OSA patients receiving operations may not simply be attributable to the changes in sleep apnea events or a reduced level of sleepiness.     

The effect of obstructive sleep apnea surgery on laryngopharyngeal reflux with obstructive sleep apnea

Abstract

Background: Obstructive sleep apnea (OSA) may play a role in the occurrence of laryngopharyngeal reflux (LPR). OSA surgery also may have a significant curative effect on LPR with OSA.

Objectives: To analyze the role of OSA in LPR and the effect of OSA surgery on LPR with OSA.

Methods: Forty-five OSA patients with LPR symptoms were enrolled and were divided into the LPR positive group (RSI > 13) and the LPR suspicious group (1?≤?RSI ≤ 13) based on reflux symptom index (RSI). All the patients underwent OSA surgery. The RSI scores at three different time points postoperatively were compared with that preoperatively.

Results: In the LPR positive and LPR suspicious group, the result revealed that there were significant differences in RSI score between one month, three months, six months after surgery and before surgery (p?<?.001 for all). Moreover, in the LPR positive group, there was a significant difference in RSI score among one month, three months and six months after surgery (p?=?.01).

Conclusions and significance: The effect of OSA on LPR exists and OSA surgery can improve the symptoms of LPR with OSA obviously. For some LPR patients with OSA, the combination therapy of OSA and LPR is needed.     

预防性气管切开术在阻塞性睡眠呼吸暂停低通气综合征手术中的应用

目的　探讨预防性气管切开术在阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapneasyn drome ,OSAS)手术中应用的意义和适应症。方法　回顾性分析 94例手术治疗的OSAS病例。将其按是否行气管切开术分成观察组和对照组。分析病史、术前术后检查、合并症、术后并发症等的差别。采用ROC(relativeoperat ingcharacteristic)曲线法确定预防性气管切开术的适应症。 结果　两组间在体重指数 (bodymassindex ,BMI)、呼吸暂停指数 (apneaindex ,AI)、呼吸暂停低通气指数 (apnea/hypopneaindex ,AHI)、最低血氧饱和度 (thelowestoxygensaturation ,LOS)上有明显差别。结论　气管切开术可有效防止OSAS围手术期致死性并发症的发生。OSAS手术中预防性气管切开术适应症 :①LOS <6 0 %。②AHI≥ 5 0 ,AI≥ 4 0。③重度OSAS合并较严重高血压病、心脏病、慢性阻塞性肺疾病等心血管、肺和脑疾病。④有严重缺氧症状者。⑤体重明显超重 ,BMI≥ 30 ,颈粗短、小下颌、舌根后坠、舌体肥大者。⑥同时行鼻部手术者。     

Maxillofacial surgery and obstructive sleep apnea syndrome

Maxillofacial surgery has proven to be an effective method for controlling OSA syndrome, and its results are as effective as those obtained with nasal CPAP. The presurgical evaluation, which includes polysomnography, physical examination, fiberoptic pharyngoscopy, and cephalometric analysis, is essential in directing surgical therapy. With phased reconstruction of the upper airway there is an excellent chance of correcting the obstructive process and eliminating the associated problems of OSA syndrome.     

Resolution of obstructive sleep apnea following facial surgery

Compared to uvulopalatopharyngoplasty (UPPP), maxillo-facial surgery is rarely performed in Canada for treatment of obstructive sleep apnea. However, in patients with retrolingual obstruction, UPPP cannot be expected to result in good surgical outcome. We describe a patient with retrognathia causing airway obstruction at the base of the tongue, in whom sagittal mandibular osteotomy with hyoid bone advancement resulted in resolution of snoring and sleep apnea.     

Long-term changes in quality of life after surgery for pediatric obstructive sleep apnea

OBJECTIVE: To study long-term changes in quality of life in children after adenotonsillectomy for obstructive sleep apnea (OSA) documented by polysomnography. DESIGN AND SETTING: Prospective study of children with OSA at the University of New Mexico Children's Hospital, Albuquerque. METHODS: Children who met inclusion criteria underwent adenotonsillectomy. Caregivers were asked to complete the OSA-18 quality of life survey prior to surgery (survey 1), within 7 months after surgery (short-term) (survey 2), and between 9 and 24 months after surgery (long-term) (survey 3). Scores from the preoperative and postoperative surveys were compared using the paired t test. RESULTS: The study population included 34 children, 27 (79%) of whom were male. The mean age of the children at the time of inclusion in the study was 6.7 years (range, 3.0-16.8 years). The mean total score for survey 1 (76.7) was significantly higher (P<.001) than the mean total score for survey 2 (32.0) or for survey 3 (40.9). However, the domains of sleep disturbance and physical suffering were significantly lower (P相似文献   

Nasal surgery for snoring in patients with obstructive sleep apnea

OBJECTIVE: To evaluate the efficacy of nasal surgery to relieve snoring and to identify predictive factors. STUDY DESIGN: Prospective comparative study. METHODS: Fifty-two consecutive patients (51 males; mean age, 38 yr; body mass index, 25.4 +/- 5.2 kg/m2) were enrolled. All patients had been previously diagnosed with obstructive sleep apnea (apnea/hypopnea index, 38.5 +/- 33.2 events/hr) and symptomatic nasal obstruction secondary to deviated nasal septum. Septomeatoplasty alone was the treatment in this study cohort. Snoring was assessed by Snore Outcome Survey (SOS), and nasal obstruction was assessed by visual analogue scale (VAS) and anterior rhinomanometry at baseline and approximately 3 months after nasal surgery. RESULTS: Body mass index remained unchanged (P > .05) after surgery. Significantly improved SOS (P < .001), VAS (P < .001), and total nasal resistance (P = .002) were noted after nasal surgery. Eighty-six percent of patients had improved SOS scores, and average improvement was 46%. Complete relief of snoring was reported by the sleep partners of six (12%) patients. Change in SOS scores (22.5 +/- 14.5 vs. 10.1 +/- 10.4) significantly differed (P = .01) between tonsil size grade (TON) 0/I and TON II/III groups. Other baseline variables did not significantly differ (P > .05) in SOS score changes. CONCLUSIONS: In patients with obstructive sleep apnea suffering from both snoring and nasal obstruction, nasal surgery for deviated septum relieves snoring in 12%. The tonsil size affects the outcome of nasal surgery for snoring.     

阻塞性睡眠呼吸暂停低通气综合症手术的麻醉期处理

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）手术的麻醉期处理,减少手术麻醉风险。 方法对145例OSAHS患者根据咽部暴露程度进行Mallampati分级。快速气管插管组114例（Ⅰ～Ⅱ级）,清醒气管插管组25例（Ⅲ～Ⅳ级）,气管切开组6例（清醒气管插管组中体重大于100kg、短颈者）。快速气管插管组术毕待患者完全清醒后拔除气管导管、送监护病房。清醒气管插管组和气管切开组术后送重症监护室监护。 结果快速气管插管组和气管切开组均顺利插入导管,清醒气管插管组7例出现呼吸抑制,面罩辅助呼吸后插入导管。三组均未发生上呼吸道梗阻。快速气管插管组6例拔管时出现恶心、呕吐,8例出现呼吸抑制。 结论降低阻塞性睡眠呼吸暂停低通气综合征手术的围术期风险须重视术前访视,正确选择麻醉诱导方法,加强术中管理、合理选择用药,严格掌握拔管指证,加强术后监护。     

儿童阻塞性睡眠呼吸暂停低通气综合征手术疗效分析

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)手术成功和失败的原因,以提高手术预评估水平,提高手术疗效。方法将我院2003年3月～2006年3月手术治疗的112例临床资料完整的OSAHS患儿进行疗效分析。其中,扁桃体加腺样体切除56例;单纯扁桃体切除41例,包括单侧扁桃体切除2例;单纯腺样体切除15例。结果治愈102例(91.1%),包括单侧扁桃体切除后对侧扁桃体代偿增生肥大者2例,再次行对侧扁桃体切除后治愈;显效9例(8.0%),包括肥胖4例,咽淋巴增生1例,鼻部阻塞4例;好转1例(0.9%),为肥胖伴下颌骨后缩者;无效0例。结论儿童OSAHS大多手术疗效较好,少数肥胖、鼻部阻塞、咽淋巴环增生及下颌后缩者疗效欠佳。在腺样体、扁桃体手术前同时应考虑解除其他部位阻塞或无创通气治疗,方可进一步提高手术疗效。对肥胖患儿还应加以减肥治疗。