多平面分期手术对重度阻塞性睡眠呼吸暂停低通气综合征合并代谢综合征患者的影响

目的观察多平面分期手术对重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并代谢综合征（metabolic syndrome，MS）患者颈动脉内膜中层厚度（carotid intimamedia thickness，IMT）及代谢指标的影响。方法选择重度OSAHS合并MS患者45例，均行多平面手术治疗，并对其治疗前及治疗后12个月患者呼吸暂停低通气指数（AHI）、体重指数（BMI）、最低血氧饱和度（LSaO2）、血脂总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）、空腹血糖（FBG）及空腹胰岛素（INS）检查，PSG监测及嗜睡评分（ESS）。结果治疗前两组比较除AHI差异具有统计学意义外（P〈0．05），其余年龄、BMI、LSaO2、LDL—C、HDL—C、TC、TG、FBG、INS、ESS及IMT的比较差异均无统计学意义（P〉0．05）；所有患者治疗前、后AHI、LSaO2、TC、TG、LDL—C、HDL—C、FBG、INS、ESS及IMT的比较，除FBG差异无统计学意义外（P〉0．05），其余差异均具有统计学意义（P〈0．05）；有效组IMT、ESS、AHI及LSaO2治疗前后比较差异具有统计学意义（P〈0．05），无效组IMT值和LSaO2治疗前后比较差异无统计学意义（P〉0．05），而ESS和AHI治疗前后比较有显著性差异（P〈0．05）。结论多平面手术对重度OSAHS合并有MS患者均有效，提示积极手术干预治疗OSAHS同时也可治疗MS；OSAHS可能是MS病情发展的一个重要因素；经过手术治疗可以逆转或延迟颈动脉粥样硬化的进程。

Influence of multiplanar staging surgery on carotid intima media thickness and metabolic index of patients with severe obstructive sleep apnea hypopnea syndrome and metabolic syndrome

Objective To observe the influence of muhiplanar staging surgery on carotid intima-media thickness and metabolic index of patients with severe obstructive sleep apnea hypopnea syndrome （ OSAHS ） and metabolic syndrome （ MS ）. Methods 45 cases suffering from severe OSAHS with MS received multiplanar surgical treatment and were divided into effective group and ineffective group according to the therapeutic effect. Detection of blood total AHI BMI ,LSaO2 , cholesterol （TC）, triglyceride （TG）, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （ HDL-C ） , FBG, INS 、 ESS and polysomonography （ PSG ） monitoring was performed in all patients before operation and 12 months after treatment. Results Before operation, the difference of apnea hypopnea index （AHI） between the two groups was significant （P 〈0.05）, while those of age, BMI, LSaO2, LDL-C, HDL- C, CHOL, TG, FBG, INS, ESS and IMT were insignificant （ P 〉 0. 05 ）. 12 months after treatment, changes of AHI, LSaO2 , CHOL, TG, LDL-C, HDL-C, INS, ESS and IMT were significant in both groups （P 〈 0. 05 ）,except that of FBG （P 〉 0.05 ）. Comparison of above-mentioned indexes before and 12 months after operation showed significant differences of IMT, ESS, AHI and LSaO2 in the effective group （ P 〈 0.05 ） , and ESS and AHI in the ineffective group （ P 〈 0.05 ）. Conclusions Muhiplanar surgery is effective for patients with severe OSAHS and MS. Positive surgical intervention of OSAHS may facilitate the treatment of MS. OSAHS may be an important factor in the development of MS. Surgical intervention of OSAHS may reverse or delay the process of carotid atherosclerosis.