【摘要】：目的 研究懸雍垂腭咽成形術(shù)(UPPP)聯(lián)合下鼻甲低溫等離子射頻消融術(shù)治療重度阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)的療效及聯(lián)合手術(shù)治療的臨床依據(jù)。 方法 對經(jīng)臨床檢查和整夜睡眠監(jiān)測確診為重度OSAHS的患者,而且,這些患者臨床及影像學等輔助檢查考慮阻塞部位以腭咽平面狹窄和單純下鼻甲肥大為主的OSAHS患者100例,隨機分為兩組,實驗組進行UPPP聯(lián)合下鼻甲消融術(shù),對照組為單純UPPP手術(shù)組,術(shù)后半年隨訪并復查PSG、ESS等進行主客觀療效評價并進行統(tǒng)計學分析。全部患者于術(shù)前常規(guī)行持續(xù)正壓通氣(Continuous Positive Airway Pressure,CPAP)治療5-7d,并在專人指導下填寫ESS睡眠評分(Epworth sleepiness scale, ESS)量表,實驗組全部患者均同期行UPPP聯(lián)合下鼻甲射頻消融術(shù),下鼻甲射頻消融術(shù)采用美國Arthrocare公司ENTec-CoblatorⅡ低溫等離子射頻治療儀及配套射頻刀頭,對照組為單純UPPP手術(shù)組,手術(shù)結(jié)束后進入ICU監(jiān)護治療12～24h,應(yīng)用抗生素及止血藥2d,氫化可的松靜滴100～150mg／d,療程2-3d,并行咽部霧化吸入。術(shù)后應(yīng)用羥甲唑啉棉片收斂鼻腔。 統(tǒng)計學處理應(yīng)用SPSS13.0軟件包進行分析,計量資料以(x±s)表示,比較運用t檢驗,計數(shù)資料比較運用x2檢驗,P0.05為差異有統(tǒng)計學意義。 結(jié)果 1.術(shù)后反應(yīng)及并發(fā)癥：患者手術(shù)時間60～120min,手術(shù)出血量均50ml,全部病例術(shù)后耐受性良好,術(shù)后24-48h出現(xiàn)局部疼痛和腫脹,2例患者出現(xiàn)一過性鼻粘膜糜爛,未出現(xiàn)大出血、窒息等嚴重并發(fā)癥。術(shù)后6個月臨床復查、隨訪,實驗組患者術(shù)后鼾聲、呼吸暫停及白天嗜睡等癥狀明顯減輕或消失、鼻塞改善。對照組除鼻腔阻塞無改變外,其他癥狀也不同程度的改善。 2.術(shù)后6個月臨床和PSG、ESS評分復查,根據(jù)2009年中華醫(yī)學會耳鼻咽喉頭頸外科學分會制定的療效評定標準。本研究實驗組總有效率為78.0%；對照組總有效率為56.0%。實驗組與對照組相比,總有效率差異有統(tǒng)計學意義(P0.05)呼吸暫停低通氣指數(shù)(AHI)、最低血氧飽和度(LSaO2)、ESS評分指標差異有統(tǒng)計學意義(P0.01), BMI差異無統(tǒng)計學意義(P0.05) 結(jié)論 1.實驗組經(jīng)過一期UPPP聯(lián)合下鼻甲低溫等離子射頻消融術(shù)后,患者臨床癥狀明顯改善,術(shù)后6個月PSG復查,總有效率、ESS評分與對照組比較差異有統(tǒng)計學意義。我們認為重度OSAHS同時伴有下鼻甲肥大患者單純行UPPP手術(shù)療效不好,需要聯(lián)合下鼻甲低溫等離子射頻消融術(shù)。 2. UPPP聯(lián)合下鼻甲低溫等離子射頻消融術(shù)治療重度OSAHS患者,與傳統(tǒng)手術(shù)或分期手術(shù)相比,該治療方案既避免患者分期手術(shù)帶來的痛苦,又減輕了經(jīng)濟負擔,在保證安全的前提下同時收到了滿意的療效。
[Abstract]:Objective to study the effect of uvulopalatopharyngoplasty (UPPP) combined with inferior turbinate hypothermia plasma radiofrequency ablation (RPA) in the treatment of severe obstructive sleep apnea hypopnea syndrome (OSAHS). Methods patients with severe OSAHS were diagnosed by clinical examination and overnight sleep monitoring. These patients were randomly divided into two groups: UPPP combined with inferior turbinate ablation, and 100 patients with OSAHS with palatopharynx plane stenosis and simple inferior turbinate hypertrophy were taken into account in the clinical and imaging examinations, the patients in the experimental group were treated with UPPP combined with inferior turbinate ablation. The control group was treated with simple UPPP operation. The patients were followed up half a year after operation and PSG,ESS was reviewed to evaluate the subjective and objective effects and to carry out statistical analysis. All the patients were treated with continuous positive pressure ventilation (Continuous Positive Airway Pressure,CPAP) for 5-7 days before operation, and the ESS sleep score (Epworth sleepiness scale, ESS) scale was filled out under the guidance of special person. All the patients in the experimental group were treated with UPPP combined with radiofrequency ablation of inferior turbinate at the same time. The inferior turbinate radiofrequency ablation was performed with ENTec-Coblator 鈪，

本文編號：2212877