鼻腔扩容术治疗鼻塞伴OSAHS病人的疗效观察
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摘要
目的:观察鼻腔扩容术治疗鼻塞伴阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)病人的疗效,探讨鼻腔结构改变对OSAHS病人睡眠质量及鼻阻力的影响。方法:选取鼻塞并伴有睡眠打鼾病人99例,术前2 h内分别进行视觉模拟量表鼻塞症状评分、匹兹堡睡眠质量指数量表评分、Epworth嗜睡量表(epworth sleepiness scale,ESS)评分和多导睡眠描记图检查及鼻阻力测定;根据监测所得的呼吸暂停低通气指数(apnea hypopnea index,AHI)和最低血氧饱和度(lowest oxygen saturation,LSa O2),将研究对象分为OSAHS轻度病人48例,中度43例,重度8例。全麻下行鼻内镜鼻腔扩容术,随访至术后第6个月,比较手术前后以上指标的变化。结果:手术前后,轻、中度组病人鼻阻力和AHI均明显低于重度组,轻度组均明显低于中度组(P <0. 01);轻度病人的LSa O2均高于中、重度组(P <0. 05～P <0. 01)。术前轻、中度病人的ESS评分均明显低于重度组(P <0. 01),术后3组病人的ESS评分差异无统计学意义(P> 0. 05)。3组病人术前、术后PSQI评分间差异均无统计学意义(P> 0. 05)。与手术前比较,手术后3组病人鼻阻力和ESS评分均明显降低(P <0. 01)。结论:鼻腔扩容术能明显降低鼻阻力,改善轻、中度OSAHS病人的嗜睡程度,对重度OSAHS病人血氧饱和度有提高。
Objective: To observe the efficacy of nasal cavity expansion surgery in the treatment of nasal obstruction complicated with obstructive sleep apnea hypopnea syndrome( OSAHS),and explore the effects of nasal structure change on sleep quality and nasal resistance in patients with OSAHS. Methods: The visual analogue scale score for nasal congestion,Pittsburgh sleep quality index( PSQI) scale,Epworth sleepiness scale( ESS),polysomnography( PSG) map and nasal airway resistance in 99 patients with snoring complicated with nasal obstruction were examined before 3 days of operation. The patients were divided into the mild OSAHS group( n =48),moderate OSAHS group( n = 43) and severe OSAHS group( n = 8) according to the apnea hypopnea index( AHI) and lowest oxygen saturation( LSa O2). All patients were treated with nasal endoscopic expansion,and followed up for 6 months. The index changes between before and after operation among three groups were compared. Results: Before and after operation,the nasal resistance and AHI in mild and moderate OSAHS groups were significantly lower than those in severe OSAHS group,which in mild OSAHS group was significantly lower than that in moderate OSAHS group( P < 0. 01),and the LSa O2 in mild OSAHS group was higher than that in moderate and severe OSAHS groups( P < 0. 05 to P < 0. 01). Before operation,the ESS score in mild and moderate OSAHS groups were significantly lower than that in severe OSAHS group( P < 0. 01),and the difference of the ESS score among three groups was not statistically significant after operation( P > 0. 05). The difference of the PSQI score among three groups before and after operation was not statistically significant after operation( P > 0. 05). Compared with before operation,the scores of the nasal resistance and ESS in three groups significantly decreased after operation( P < 0. 01). Conclusions: Nasal cavity expansion surgery can significantly decrease the nasal airway resistance,improve the symptom of sleepiness in patients with mild or moderate OSAHS,and improve the LSa O2 of patients with severe OSAHS.
Objective: To observe the efficacy of nasal cavity expansion surgery in the treatment of nasal obstruction complicated with obstructive sleep apnea hypopnea syndrome( OSAHS),and explore the effects of nasal structure change on sleep quality and nasal resistance in patients with OSAHS. Methods: The visual analogue scale score for nasal congestion,Pittsburgh sleep quality index( PSQI) scale,Epworth sleepiness scale( ESS),polysomnography( PSG) map and nasal airway resistance in 99 patients with snoring complicated with nasal obstruction were examined before 3 days of operation. The patients were divided into the mild OSAHS group( n =48),moderate OSAHS group( n = 43) and severe OSAHS group( n = 8) according to the apnea hypopnea index( AHI) and lowest oxygen saturation( LSa O2). All patients were treated with nasal endoscopic expansion,and followed up for 6 months. The index changes between before and after operation among three groups were compared. Results: Before and after operation,the nasal resistance and AHI in mild and moderate OSAHS groups were significantly lower than those in severe OSAHS group,which in mild OSAHS group was significantly lower than that in moderate OSAHS group( P < 0. 01),and the LSa O2 in mild OSAHS group was higher than that in moderate and severe OSAHS groups( P < 0. 05 to P < 0. 01). Before operation,the ESS score in mild and moderate OSAHS groups were significantly lower than that in severe OSAHS group( P < 0. 01),and the difference of the ESS score among three groups was not statistically significant after operation( P > 0. 05). The difference of the PSQI score among three groups before and after operation was not statistically significant after operation( P > 0. 05). Compared with before operation,the scores of the nasal resistance and ESS in three groups significantly decreased after operation( P < 0. 01). Conclusions: Nasal cavity expansion surgery can significantly decrease the nasal airway resistance,improve the symptom of sleepiness in patients with mild or moderate OSAHS,and improve the LSa O2 of patients with severe OSAHS.
引文
[1]谢仕津,梁灼萍,黎万荣.阻塞性睡眠呼吸暂停低通气综合征的病因与诊治研究现状[J].西南军医,2011,13(3):505.
[2]彭易坤,胡德峰,吴欣华.阻塞性睡眠呼吸暂停低通气综合征病人双侧鼻腔扩容术前后鼻腔通气程度主客观的变化[J].武汉大学学报(医学版),2015,36(6):952.
[3]叶京英,李五一.阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南解读[J].中华耳鼻咽喉头颈外科杂志,2009,44(2):91.
[4]韩德民.鼻腔扩容技术的临床意义[J].中华耳鼻咽喉头颈外科杂志,2011,46(2):89.
[5]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会咽喉学组.阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J].中华耳鼻咽喉头颈外科杂志,2009,44(2):95.
[6]中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9.
[7]李刚.鼻腔扩容术对阻塞性睡眠呼吸暂停低通气综合征病人影响的相关研究[J].中国眼耳鼻咽喉科杂志,2015,15(4):285.
[8]彭易坤.鼻腔扩容术在OSAHS治疗中的应用及临床疗效评估[J].山东大学耳鼻喉眼学报,2017,31(1):13.
[9]JOHNS MW. A new method for measuring daytime sleepiness:the Epworth sleepiness scale[J]. Sleep,1991,14(6):540.
[10]王俊力,夏进,王菊芬.女性阻塞性睡眠呼吸暂停低通气综合征的危险因素及治疗现状分析[J].四川大学学报(医学版),2011,42(4):535.
[11]龚为群,阎萍,杨世权. Epworth嗜睡量表联合匹兹堡睡眠质量指数在不同程度鼻源性OSAHS病人中的观察[J].重庆医学,2016,11(45):4549.
[12]孙晋渊,郭雪君,刘松.中、重度OSAHS病人白天嗜睡、睡眠质量及心理抑郁情况的量表分析[J].国际呼吸杂志,2016,36(23):1800.
[13]SHIN SH,YEMKA,KIM CG. Modified uvuiopaiatopharyngopiasty for the treatment of obstructive sieep apnea-hypopnea syndrome; resection of the musculus uvuiae[J]. Otoiaryngol Head Neck Surg,2009,140(6):924.
[14]GUIMARES C,MARTINS MV,VAZ RODRIGUES L,et al.Epworth Sleepiness Scaie in obstructive sleep apnea syndrome-an underestimated subjective scale[J]. Rev Port Pneumol,2012,18(6):267.
[15]曹鄂洪,朱美英,施毅.单纯鼻部手术对伴有鼻阻的阻塞性睡眠呼吸暂停低通气综合征病人睡眠的影响[J].山东大学耳鼻喉眼学报,2013,27(1):12.
[2]彭易坤,胡德峰,吴欣华.阻塞性睡眠呼吸暂停低通气综合征病人双侧鼻腔扩容术前后鼻腔通气程度主客观的变化[J].武汉大学学报(医学版),2015,36(6):952.
[3]叶京英,李五一.阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南解读[J].中华耳鼻咽喉头颈外科杂志,2009,44(2):91.
[4]韩德民.鼻腔扩容技术的临床意义[J].中华耳鼻咽喉头颈外科杂志,2011,46(2):89.
[5]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会咽喉学组.阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J].中华耳鼻咽喉头颈外科杂志,2009,44(2):95.
[6]中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9.
[7]李刚.鼻腔扩容术对阻塞性睡眠呼吸暂停低通气综合征病人影响的相关研究[J].中国眼耳鼻咽喉科杂志,2015,15(4):285.
[8]彭易坤.鼻腔扩容术在OSAHS治疗中的应用及临床疗效评估[J].山东大学耳鼻喉眼学报,2017,31(1):13.
[9]JOHNS MW. A new method for measuring daytime sleepiness:the Epworth sleepiness scale[J]. Sleep,1991,14(6):540.
[10]王俊力,夏进,王菊芬.女性阻塞性睡眠呼吸暂停低通气综合征的危险因素及治疗现状分析[J].四川大学学报(医学版),2011,42(4):535.
[11]龚为群,阎萍,杨世权. Epworth嗜睡量表联合匹兹堡睡眠质量指数在不同程度鼻源性OSAHS病人中的观察[J].重庆医学,2016,11(45):4549.
[12]孙晋渊,郭雪君,刘松.中、重度OSAHS病人白天嗜睡、睡眠质量及心理抑郁情况的量表分析[J].国际呼吸杂志,2016,36(23):1800.
[13]SHIN SH,YEMKA,KIM CG. Modified uvuiopaiatopharyngopiasty for the treatment of obstructive sieep apnea-hypopnea syndrome; resection of the musculus uvuiae[J]. Otoiaryngol Head Neck Surg,2009,140(6):924.
[14]GUIMARES C,MARTINS MV,VAZ RODRIGUES L,et al.Epworth Sleepiness Scaie in obstructive sleep apnea syndrome-an underestimated subjective scale[J]. Rev Port Pneumol,2012,18(6):267.
[15]曹鄂洪,朱美英,施毅.单纯鼻部手术对伴有鼻阻的阻塞性睡眠呼吸暂停低通气综合征病人睡眠的影响[J].山东大学耳鼻喉眼学报,2013,27(1):12.