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。

Comparison of tolerance to sequential continuous positive airway pressure therapy between patients after classical and after modified uvulopalatopharyngoplasty]

OBJECTIVE: To investigate the effect of uvulopalatopharyngoplasty (UPPP) on postoperation continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: 66 OSAHS patients underwent UPPP were recruited and all were followed up for more than 12 months. Among them 24 patients were treated with classical UPPP, 42 had modified UPPP treatment. The efficacy of surgery was compared between the two groups. The post-operation tolerance to CPAP pressure was tested during sleep CPAP titration in 24 classical UPPP patients and in 15 modified UPPP patients. RESULTS: The validity ratio is 58.3% and 61.9% 12 months after operation. There was no significant difference between classical UPPP and modified UPPP in regard to surgery efficacy, and most of them need further CPAP therapy. During CPAP treatment, compared with untreated OSAHS patients, the highest CPAP pressure classical UPPP group could tolerant decreased significantly, however, classical UPPP group did not. 16.7% of classical UPPP patients had severe mouth air leak before optimal CPAP pressure was titrated, but none of the 15 post modified UPPP failed to sequential CPAP therapy. CONCLUSION: The efficacy was similar between modified UPPP and classical UPPP treatment, post modified UPPP patients had better tolerance to sequential CPAP treatment. It may be better to treat OSAHS patients with modified UPPP instead of classical UPPP.