重症阻塞性睡眠呼吸暂停低通气综合征的阻塞平面及疗效分析

目的 探讨重症阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的阻塞平面及治疗方案，选择联合改良悬雍垂腭咽成形术(H-UPPP)＋舌骨悬吊术(Hyoid suspension)+鼻腔手术的手术疗效，及持续正压通气(CPAP)治疗的依从性。方法 以多导睡眠分析系统(PSG，SW-SM2000c型)监测诊断符合OSAHS，接受治疗并成功随访的重症患者60例，治疗前进行PSG、电子鼻咽镜及颅骨正位片检查，确定阻塞平面，了解舌骨位置，根据患者年龄选择不同的治疗方式，随访复查PSG，评价不同治疗方式的效果。结果 60例均为多平面阻塞，其中24例采用H-UPPP+舌骨悬吊术＋鼻腔手术，有效率为83.3%。24例中有20例并发高血压病或糖尿病，术前请相关科室会诊，给予降压、降糖治疗，改善心肌缺血情况。鼻腔病变鼻内镜下行鼻中隔偏曲矫正＋双侧下鼻甲骨折外移或鼻息肉切除＋鼻窦开放术。而36例重症老年患者，选择CPAP治疗，依从性达88%。结论 重症OSAHS患者，依据阻塞部位，选择适宜的手术方案，而不宜手术治疗的重症老年患者，可以采用CPAP辅助通气，治疗效果满意。

Obstructive planes and therapeutic efficacy in severe obstructive sleeping hypopnea-apnea syndrome

Objective To explore the obstructive planes and treatment of severe obstructive sleeping hypopnea-apnea syndrome (OSAHS) by evaluating the efficiacy of H-UPPP, Hyoid suspension plus nasal operation, and compliance of CPAP. Methods 60 cases of patients underwent PSG and were diagnosed as severe OSAHS. And all the patients received PSG again after the operation or CPAP treatment. Results 60 patients were all multi-level obstructive. HUPPP, hyoid suspension and nasal operation were performed in 24 cases, while 20 of them presented with hypertension or diabetes. Nasal operations consisted of inferior turbinectomy, nasal septum reconstructomy or endoscopic surgery. CPAP treatment was applied in the rest 36 elderly patients. Conclusion For the severe OSAHS patients, suitable and feasible surgery should be done according to the obstructive planes. As for elderly patients, CPAP is a good choice. The good results can be achieved in all the severe OSAHS cases.