中重度阻塞性睡眠呼吸低通气综合征UPPP联合鼻内镜手术的综合治疗

目的分析阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的临床资料,探讨中重度OSAHS患者的治疗经验。方法对56例中重度OSAHS患者,实施UPPP手术联合鼻中隔矫正等多平面手术,其中部分不接受CPAP治疗的重症OSAHS患者实施气管切开术,予以控烟、戒酒等行为治疗等综合治疗措施,术后随访6个月以上,判断疗效。对是否行气管切开手术的两组患者的年龄、打鼾病史、BMI等进行比较分析。结果患者术后打鼾明显减轻,呼吸暂停次数明显减少,血压、血糖等控制较为理想,气管切开术的重症患者出院前能顺利拔管。两组患者打鼾病史、BMI比较有统计学意义,气管切开组患者的打鼾病史较长（13.40±9.74）年/（7.98±3.04）年,P=0.02]、年龄普遍偏大（45.74±6.27）岁/（41.76±9.76）岁,P=0.11）、BMI指数提示超重和肥胖居多（32.38±10.34）/（26.34±3.15）,P=0.02]。结论 UPPP联合鼻内镜手术的综合治疗是中重度OSAHS的有效措施;对于病史较长、年龄偏大、超重甚至肥胖的重度OSAHS患者,气管切开术是重要的预防措施之一。

The combined modality therapy of UPPP and endoscopic surgery in moderate and severe OSAHS

Objective To explore the therapeutic experience of moderate and severe OSAHS by analyze the clinical material of the patients suffered by obstructive sleep apnea hypopnea syndrome（OSHAS）. Methods 56 cases of moderate and severe OSAHS were underwent UPPP plused nasal septum modification who were suffered by multyplanic obstruction such as nasal septum deviation,pharyngeal or post soft palatic grudge stenosis,bursa pharyngea and so on. Several severe cases of OSAHS were performed tracheotomy who were not willing to accept CPAP therapy（continuous positive pressure therapy,CPAP）,and behavior therapy such as smoke contral,alcohol refration,physical exercise et al during the postoperative restoration period. The therapeutic effects were evaluated after 6 months of postoperative follow up. The frequency of the age,snoring history,BMI,et al of the OSAHS were statisticed by SPSS 13.0 for windows. The T test was used to analyse the difference between the two groups of the tracheotomy and the nontracheotomy. Results A total of 56 patients undergoing combined therapy such as UPPP plused nasal septum modification and so on,their snoring had alleviated,apnea decreased obviously,their blood pressure and blood glucose become ideal after 6 months or more time of following up. The severe OSAHS underwent tracheostomy could be extubated successfully prior to their discharge. There were statistically significant in snoring history and BMI but age between the two groups of tracheotomy and nontracheotomy OSAHS. The mean snoring history of the tracheotomy group of OSAHS was longer than the later group（13.40±9.74/7.98±3.04,P=0.02,year）,the mean BMI of the group of tracheotomy of OSAHS was more than the later group（32.38±10.34/26.34±3.15,P=0.02,kg/m^2）,The group of tracheotomy of OSAHS had longer history of snoring,most of them were more hypergravity,obesitas and older than the later group（45.74±6.27/41.76±9.76,P=0.11）. Conclusion the combined therapy modality of UPPP plused nasal septum modification and behavthe