上气道持续压力测定预测悬雍垂腭咽成形术的疗效  

Preoperative overnight airway pressure measurement for predicting the outcome of revised uvulopalatopharyngoplasty

作　　者：韩德民[1] 叶京英[1] 李彦如[1] 张玉焕[1] 王小轶[1] 尹国平[1] 丁秀[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2006年第10期753-758,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家十五攻关资助项目(2004BA720A17)

摘　　要：目的以上气道-食管持续压力测定定位阻塞性睡眠呼吸暂停患者咽腔阻塞部位,评价定位诊断指标预测悬雍垂腭咽成形术疗效的准确性。方法以整夜多道睡眠监测与同步上气道-食管压力持续测定对患者每次咽腔阻塞的部位定位,以腭咽、舌咽、喉咽各平面来源的气遭阻塞、塌陷次数占总次数的构成比定量表示各平面参与气道塌陷的作用大小。对27例选择改良悬雍垂腭咽成形术治疗的患者进行随访,术后6个月复查多道睡眠监测,结果以呼吸暂停低通气指数(apnea andhypopnea index,AHI)较术前下降的比例≥50%为显效标准,手术总显效率51.9%。AHI 下降比例与腭咽构成比和腭咽阻塞指数正相关(r 分别为0.609和0.521),与舌咽构成比负相关(r=-0.479)。术后 AHI 与腭咽构成比、舌咽构成比和阻塞指数相关(r 分别为-0.675、0.542和0.647)。腭咽构成比≥70%者10例,9例手术显效,腭咽构成比<60%者10例,无显效者。以腭咽构成比≥60%作为预测手术显效的标准,预测一致率88.9%(24/27)。综合舌咽阻塞指数,腭咽、舌咽构成比、扁桃体大小及其他多道睡眠监测指标对术后 AHI 进行多元线性回归分析,r^2=0.632(F=6.701,P=0.001)。结论以上气道-食管持续压力测定各阻塞平面参与气道塌陷的作用大小,可较好地预测腭咽平面气道重建手术的疗效。以腭咽构成比为指标,可获得88.9%的预测一致率。Objective The distribution of upper airway obstruction sites can be identified quantitatively and dynamically with continuous airway pressure measurements in obstructive sleep apnea hypopnea syndrome （ OSAHS ） patients. Its value as a clinical predictor for the outcome of revised uvulopalatopharyngoplasty was evaluated. Methods The upper airway obstruction sites （transpalatal level, tongue base or hypolarynx level ） were determined preoperatively with overnight upper airway pressure monitoring and concurrent polysomnography （PSG）. Of one＇s total amount of obstructive events, the proportion of apnea/hyponea events located at Transpalatal level was quantified as contribution of transpalatal obstruction. Of all OSAHS patients, 26 males and 1 female underwent revised uvulopalatopharyngoplasty （2 had same stage transpalatal advancement pharyngoplasty） and had follow-up PSG 6. 33 ±0. 84 months after surgery. The relationship of transpalatal obstruction proportion, age, tonsil size and body mass index （BMI） and the reduction in apnoea hypopnea index （AHI） was analyzed. Results The AHI （times/hr） of 27 subjects decreased from 63.9 ±20. 7 to 28.4 ± 25.4. The response rate was 51.9% （ defined as AHI reduction over 50% ）. Correlation between the transpalatal obstruction proportion and the AHI reduction percentage was significant （r = 0. 609）, so was the degree of the tonsil size （r = 0. 511 ）. The proportion of tongue base level obstruction showed a negative correlation for the AHI reduction. Patients with oropharynx obstruction percentage 1≥ 70% had a success rate of 90% and all patients with oropharynx obstruction percentage 〈 60% responded poorly to the operation. The regression model showed distribution of obstructive sites, along with tonsil size and other PSG parameters could predict 66.7% of the postoperative AHI of transpalatal level surgery （ F = 6. 701, P = 0. 001 ） . Conclusions Contribution of transpalatal level obstruction has significant predictive value to

关 键 词：睡眠呼吸暂停 阻塞性 气道阻力 预后 治疗结果 悬雍垂腭咽成形术 

分 类 号：R766[医药卫生—耳鼻咽喉科]