鼻腔扩容术治疗以鼻塞为主的阻塞性睡眠呼吸暂停低通气综合征临床分析

目的：探讨鼻腔扩容术在治疗以鼻塞为主的阻塞性睡眠呼吸暂停低通气综合征（0sAHs）中的意义。方法：在鼻内镜下对48例伴鼻腔结构异常的OSAHS患者施行鼻腔扩容术，观察患者术后主客观症状改善情况。结果：术后12个月PSG复查，治愈60．4％（29／48），显效20．8％（10／48），有效8．3％（4／48），无效10．4％（5／48）。全部患者呼吸暂停、低通气、LSaO2和嗜睡程度明显改善，鼻塞症状明显减轻，唯有鼾声改善不甚明显。结论：鼻腔扩容术治疗以鼻塞为主的OSAHS疗效较好，其适应证是伴有鼻塞症状的0sAHs和上呼吸道阻力综合征的患者，根据患者具体病情实行个体化手术治疗可获得良好的临床效果。手术应以纠正鼻腔结构异常、调整两侧气流的对称性分布为主，以维系正常通气功能。

Clinical analysis of endoscopic nasal cavity expansion surgery for treatment of obstructive sleep apnea hypopnea syndrome

Objective： To investigate the efficacy of endoscopic nasal cavity expansion surgery on obstructive sleep apnea hypopnea syndrome （OSAHS） and nasal obstruction. Method：Clinical data of 48 OSAHS patients with structural abnormality in nasal cavity treated in our department were retrospectively analysed. These patients re- ceived endoscopic nasal cavity expansion surgery and were observed for the relief of both subjective and objective symptoms. Result：PSG was reexamined 12 months postoperatively. Of all the patients,29 cases（60.4%） showed complete recovery, 10 cases （20.8 % ） showed remarkable improvement of the symptoms, 4 cases （8.3 % ） exhibited curative effect and 5 cases（10.4%） were of no effect, respectively. The symptoms of apnea, hypopnea, LSaO2 and somnolence were significantly improved in all patients, and nasal congestion was obviously relieved. The im- provement of snore was not evident. Conclusion：Endoscopic nasal cavity expansion surgery is effective and safe for the treatment of OSAHS mainly due to nasal obstruction. Operation should be performed to correct structural ab- normality in nasal cavity and adjust symmetric distribution of nasal airflow on both sides in order to maintain nor- mal ventilation function. The procedure is applicable to OSAHS patients accompanied by nasal congestion and up- per airway resistance syndrome and personalized adjustment is beneficial for better clinical efficacy according to the condition of different patients.