持续正压通气、等离子消融和改良腭咽成形术综合治疗重症阻塞性睡眠呼吸暂停综合征

目的探讨重症阻塞性睡眠呼吸暂停低通气综合征的治疗方法,提高临床疗效和减少并发症。方法对15例经多导睡眠监测仪监测确认为重症阻塞性睡眠呼吸暂停低通气综合征患者术前进行为期1W的持续正压通气,再进行改良腭咽成形和等离子软腭、悬雍垂、舌根及下鼻甲消融,扩大咽气道。结果术后随访3~6m,无明显并发症,所有患者均取得了满意效果。患者射频治疗前和治疗12W后多导睡眠参数比较显示治疗后Ⅰ+Ⅱ期睡眠时间明显缩短,Ⅲ+Ⅳ期睡眠时间明显延长,睡眠效率及最低脉氧饱和度(LspO2)均显著提高(P<0.01);呼吸暂停低通气指数减低及打鼾时间缩短均较治疗前相比差异非常显著(P<0.01)。患者射频治疗12W后软腭长主及悬雍垂度的缩短及鼾声评级的降低均较治疗前相差非常显著(P<0.01)。Epworth嗜睡程度评分亦较治疗前明显降低(P<0.01)。结论持续正压通气、腭咽成形术和等离子消融综合治疗阻塞性睡眠呼吸暂停低通气综合征具有较好的近期疗效,且方便、安全、微创、恢复快,无不良反应,有较好的发展前景,值得推广应用。

Airway Pressure, Plasma Radiofrequency Ablation and Modified Uvuopalatopharyngoplasty Treat Severe Obstructive Sleep Apnea Syndrome

Objective To investigate the therapy methods,improve the clinical efficacy and reduce the complications on severe obstructive sleep apnea syndrome(OSAS).Methods 15 patients with polysomnographically proven serious obstructive sleep apnea hypopnea syndrome were given continue positive airway pressure for 1 week before plasma radiofrequency ablation to uvula,tongue base,soft palate and inferior turbinates and modified uvuopalatopharyngoplast enlarged oropharyngeal air duct.The polysomnography examinations were carried out before and 12 weeks after operation respectively.The snoring scale and Epworth sleepiness score(ESS) were also compared.Results Three to six months follow-up showed that Comparison of polysomnography parameters before and 12 weeks after operation showed that Ⅰ+Ⅱ phase sleep time shortened significantly,Ⅲ+Ⅳ phase sleep time prolonged,sleep efficiecy and the lowest pulse oxygen saturation improved signifiantly.In addition,there were significant differences in the decrease of apnea hypopnea index after operation (P<0.01).12 weeks after treatment,the lenth of soft palate and uvula shortened,snoring scale and ESS decreased significantly (P<0.01).Conclusion Continue positive airway pressure,plasma radiofrequency ablation and modified uvuopalatopharyngoplasty is effective to severe OSAHS at least in a short term.This treatment is convenient,simple safe and minimally invasive procedure without obvious adverse reactions.There are better prospects and it is worth popularizing and applying.