【摘要】： [目的]探討一期多平面手術(shù)治療阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)的手術(shù)療效。[方法]對(duì)190例OSAHS患者(2個(gè)平面以上狹窄)進(jìn)行鼻腔手術(shù)、舌體消融、懸雍垂腭咽成形術(shù)、硬腭截短、Repose骨螺釘舌根和(或)舌骨懸吊手術(shù)方式中的二項(xiàng)或二項(xiàng)以上的聯(lián)合手術(shù),后進(jìn)行6個(gè)月隨訪,比較資料完整的81例患者手術(shù)前后多導(dǎo)睡眠監(jiān)測(cè)及X線測(cè)量下氣道的參數(shù),評(píng)價(jià)療效。[結(jié)果]81例患者手術(shù)前后平均最低血氧飽和度由(0.71±0.01)提高至(0.82±0.07),差異均有統(tǒng)計(jì)學(xué)意義(t值分別為18.32、11.04,P值均0.01)。下咽氣道間隙由(12.1±3.2)mm增加至(16.9±2.6)mm,后氣道間隙由(9.2±3.3)mm增加至(15.6±2.4)mm,差異均有統(tǒng)計(jì)學(xué)意義(t值分別為2.5、7.6,P值分別小于0.014和0.000)。治愈28例(AHI5次／h),占39.5%,有效19例(AHI20次／h但降低幅度≥50%),占23.5%,無(wú)效2例(AHI降低幅度50%),占2.4%；治愈和顯效率達(dá)74.1%。[結(jié)論]一期多平面手術(shù)是治療OSAHS患者的有效手術(shù)方法。 [目的]研究重度OSAHS患者采用一期多平面手術(shù)治療前后血清中血管緊張素II (angiotensin II, AngⅡ)、新喋呤(neopterin, Npt)、抵抗素(resistin)、S100β濃度的變化,評(píng)估手術(shù)治療對(duì)這些因子的影響,探討OSAHS與AngⅡ、Npt、抵抗素、S100β之間的關(guān)系。[方法] 2006年5月-2009年07月于我院住院的重度OSAHS患者30例一期多平面手術(shù)治療前及術(shù)后六個(gè)月的外周血樣本,并采集30例正常健康者外周血樣本,采用ELISA方法檢測(cè)血清AngⅡ、Npt、抵抗素、S100β蛋白水平。[結(jié)果]1. AngⅡ與最低SaO2、收縮壓、AHI的變化有一定線性關(guān)系。隨著AHI次數(shù)的增加,患者血清Npt濃度也增加。抵抗素與BMI的變化有一定線性關(guān)系,隨著B(niǎo)MI的增加,抵抗素濃度增加。2. OSAHS患者術(shù)前AngⅡ、Npt、抵抗素、s100β蛋白濃度均高于健康對(duì)照組(P0.05).3. OSAHS患者手術(shù)治療后血清AngⅡ、Npt、抵抗素、S100β蛋白濃度均有不同程度下降(P0.05)。[結(jié)論]1.一期多平面手術(shù)后患者血壓下降與AngⅡ濃度降低,從而ET-1釋放減少有關(guān),AngⅡ可能在OSAHS的血壓變化中起一定作用。2.NPT是一個(gè)與OSAHS病情嚴(yán)重程度相關(guān)的因子,可以用來(lái)評(píng)估OSAS病情,評(píng)價(jià)手術(shù)效果。3. OSAHS患者手術(shù)后6個(gè)月,血清中抵抗素濃度顯著降低,可能與術(shù)后患者體重減低有關(guān)。4. OSAHS患者術(shù)前S100β蛋白濃度顯著高于對(duì)照組,采用手術(shù)治療6個(gè)月后,S100β蛋白濃度顯著降低�？赡芘c患者術(shù)后日間嗜睡癥狀緩解,記憶力明顯升高有關(guān)。
[Abstract]:[objective] to evaluate the effect of one-stage multiplanar operation on obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: a total of 190 patients with OSAHS (2 or more plane stenosis) underwent nasal surgery, tongue ablation, uvulopalatopharyngoplasty, hard palate truncated reconstruction screw hyoid root and / or hyoid suspension. After 6 months follow-up, 81 patients with complete data before and after operation were compared with polysomnography and X ray to measure the parameters of lower airway and evaluate the curative effect. [results] the mean minimum oxygen saturation increased from (0.71 鹵0.01) to (0.82 鹵0.07) in 81 patients (t = 18.32 鹵11.04, P = 0.01). The hypopharyngeal airway space increased from (12.1 鹵3.2) mm to (16.9 鹵2.6) mm, the posterior airway space increased from (9.2 鹵3.3) mm to (15.6 鹵2.4) mm, the difference was statistically significant (t = 2.5 鹵7.6, P < 0.014 and 0.000, respectively). 28 cases were cured (AHI5 times / h), accounting for 39.5%, 19 cases were effective (AHI20 times / h but decreased by more than 50%), accounting for 23.5 cases (AHI decreased by 50%), 2 cases (AHI decreased by 50%), the effective rate was 74.1%. Conclusion one-stage multi-planar operation is an effective method for the treatment of OSAHS patients. [objective] to study the changes of serum angiotensin 鈪，

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