OSAHS患者应用改良悬雍垂腭咽成形术治疗的效果观察

目的　探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者应用改良悬雍垂腭咽成形术治疗的效果。方法　回顾性分析2015年1月至2020年1月东莞市长安医院耳鼻咽喉科收治的108例OSAHS患者临床资料，将患者以随机数字表法分为试验组和对照组，各54例。对照组男26例、女28例，年龄（39.34±3.26）岁，采取单纯腭咽成形术；试验组男28例、女26例，年龄（38.84±3.54）岁，采取改良悬雍垂腭咽成形术。比较两组患者术前及术后1个月、3个月、6个月呼吸暂停低通气指数（AHI）、Epworth嗜睡量表（ESS）、最低血氧饱和度（LSaO₂）、用力呼出75%肺活量时的瞬间呼气流量（MEF75）、第1秒用力呼吸容积（FEV1）、呼气峰流速（PEF）指标，评价两组患者临床疗效。计量资料采用独立样本t检验，计数资料采用χ²检验。结果　术后1个月、3个月、6个月，试验组AHI值分别为（18.36±1.89）次/h、（15.24±1.35）次/h、（14.09±1.25）次/h，均低于对照组（20.95±1.74）次/h、（18.63±1.42）次/h、（16.34±1.08）次/h，ESS评分分别为（7.24±1.56）分、（6.95±0.69）分、（5.67±0.35）分，均低于对照组（9.29±1.47）分、（8.33±0.72）分、（8.01±0.54）分，差异均有统计学意义（均P<0.05）。术后3个月、术后6个月，试验组MEF75指标为（89.85±7.69）%、（96.34±8.44）%，均高于对照组（84.29±7.30）%、（89.36±7.95）%，FEV1指标为（95.30±7.41）%、（99.20±7.25）%，均高于对照组（92.34±6.71）%、（94.24±6.03）%，PEF指标为（91.29±4.36）%、（95.37±5.88）%，均高于对照组（87.63±5.01）%、（91.24±5.24）%，LSaO₂指标为（85.01±6.34）%、（89.01±7.42）%，均高于对照组（80.63±5.96）%、（84.39±6.33）%，差异均有统计学意义（均P<0.05）。试验组总有效率为96.30%（52/54），显著优于对照组85.19%（46/54），差异有统计学意义（χ²=3.967，P=0.046）。结论　改良悬雍垂腭咽成形术治疗OSAHS患者近期及远期疗效更佳，对改善OSAHS患者的生活质量有重大意义。

Observation on the effect of H-uvulopalatopharyngoplasty for OSAHS patients

Objective　To investigate the efficacy of H-uvulopalatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods　The clinical data of 108 patients with OSAHS admitted to Department of Otolaryngology, Dongguan Chang'an Hospital from January 2015 to January 2020 were retrospectively analyzed. All patients were divided into an experimental group and a control group according to the random number table, with 54 cases in each group. In the control group, there were 26 males and 28 females, aged (39.34±3.26) years; in the experimental group, there were 28 males and 26 females, aged (38.84±3.54) years. The control group underwent simple palatopharyngoplasty, and the experimental group underwent H-uvulopalatopharyngoplasty. Apnea hypopnea index (AHI), Epworth Sleepiness Scale (ESS), lowest blood oxygen saturation (LSaO₂), momentary expiratory flow at 75% (MEF75), forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate (PEF) were compared between the two groups before surgery and 1, 3, and 6 months after surgery, and the clinical efficacies of the two groups were evaluated. Independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　The AHI value of the experimental group were (18.36±1.89) times/h 1 month after surgery, (15.24±1.35) times/h 3 months after surgery, and (14.09±1.25) times/h 6 months after surgery, respectively, which were lower than those of the control group (20.95±1.74) times/h, (18.63±1.42) times/h, and (16.34±1.08) times/h], the ESS scores were (7.24±1.56) points, (6.95±0.69) points, and (5.67±0.35) points, respectively, which were lower than those of the control group (9.29±1.47) points, (8.33±0.72) points, and (8.01±0.54) points], with statistically significant differences (all P<0.05). The MEF75 index of the experimental group was (89.85±7.69)% 3 months after surgery and (96.34±8.44)% 6 months after surgery, which were higher than those of the control group (84.29±7.30)% and (89.36±7.95)%], the FEV1 indexes were (95.30±7.41)% and (99.20±7.25)%, which were higher than those of the control group (92.34±6.71)% and (94.24±6.03)%], the PEF indexes were (91.29±4.36)% and (95.37±5.88) %, which were higher than those of the control group (87.63±5.01)% and (91.24±5.24)%], and the LSaO₂ indexes were (85.01±6.34)% and (89.01±7.42)%, which were higher than those of the control group (80.63±5.96)% and (84.39±6.33)%], with statistically significant differences (all P<0.05). The total effective rate of the experimental group was 96.30% (52/54), which was significantly higher than 85.19% (46/54) of the control group, with a statistically significant difference (χ²=3.967, P=0.046). Conclusion　H-uvulopalatopharyngoplasty has better short-term and long-term efficacies in the treatment of OSAHS patients, which is of great significance for improving the quality of life in patients with OSAHS.