Repose骨螺钉系统在重度阻塞性睡眠呼吸暂停低通气综合征治疗中的应用  

Suspension with Repose system in the treatment of obstructive sleep apnea-hypopnea syndrome

作　　者：王宇[1] 张颖[1] 刘至玄[1] 张京秋[1] 王效军[1] 杨光[1] 田媛[1] 冀然[1] 李志杰[1] 曹云[1] 

机构地区：[1]北京军区总医院263临床部耳鼻咽喉头颈外科北京军区耳鼻咽喉病研究诊疗中心,101149

出　　处：《中华耳鼻咽喉头颈外科杂志》2010年第2期100-104,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的介绍Repose骨螺钉系统治疗重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的手术方法。方法对32例重度OSAHS患者（Friedman分型Ⅱ、Ⅲ型，腭咽、舌咽平面塌陷）进行舌体消融、悬雍垂腭咽成形、硬腭截短、Repose骨螺钉舌根和（或）舌骨悬吊手术后进行6个月随访，比较患者手术前后多道睡眠监测及x线测量下咽气道参数，评价疗效。结果32例患者手术前后平均体质量指数差异无统计学意义（P〉0．05）；平均呼吸暂停低通气指数（AHI）由（78．3±11．6）次／h（x±s，下同）降低至（18．4±12．5）次／h，最低血氧饱和度由0．632±0．007提高至0．794±0．006，差异均有统计学意义（t值分别为13．5、4．1，P值均〈0．01）。下咽气道间隙由（12．1±3．2）mm增加至（16．9±2．6）mm，后气道间隙由（9．2±3．3）mm增加至（15．6±2．4）mm，差异均有统计学意义（t值分别为2．5、7．6，P值分N／J,于0．05和0．01）。治愈6例（AHI〈5次／h），占18．8％；显效24例（AHI〈20次／h且降低幅度≥50％），占75．0％；治愈和显效率达93．8％。在32例手术患者中，3例舌根牵引患者术后3～7d出现口底异物感，6个月左右消失；1例舌根牵引术后3个月左右发现下颌边缘性骨髓炎，抗感染治疗5d后痊愈；1例舌根牵引术患者术后7d舌下区出血，予以压迫止血后出血止；1例舌骨悬吊术患者术后5d发现下颌积血，切开引流，加压包扎1周后痊愈。结论Repose骨螺钉系统用于重度OSAHS患者的联合手术中安全有效。Objective To introduce the treatment of severe obstructive sleep apnea - hypopnea syndrome （OSAHS） with Repose bone screw system and to evaluate the treating effect. Methods Thirty-two patients with severe OSAHS （Friedman classification Ⅱ, Ⅲ ） were treated with tongue ablation ＋ uvulopalatopharyngoplasty ＋ hard palate shortening ＋ Repose suspension. All patients were followed-up for 6 months. Apnea hypopnea index （AHI）, lowest oxygen percent saturation （LSaO2 ）, body mass index （BMI）, vallecula epiglottica-lateral pharyngeal wall （V-LPW） and pharyngeal airway space （PAS） were used for the diagnosis and evaluation. Results The AHI in 32 patients reduced from （78.3± 11.6）/h to （18.4± 12.5）/h （x±s）, t =13.5, P =0.000. The LSaO2 increased from （0.632±0.007） to （0.794 ± 0. 006） ,t =4. 1, P = 0. 000. The BMI was statistical indiscriminate. The V-LPW increased from （ 12. 1± 3.2） mmto （16.9±2.6） mm （t=2.5, P=0.014）. PASinereasedfrom （9.2±3.3） mmto （15.6± 2.4） mm （t = 7. 6, P = 0. 000）. The total effective rate was 93.8%. Three genioglossus stabilization patients complained about foreign body sensation in the mouth floor 3 - 7 days after procedures, which disappeared in 6 months. One genioglossus stabilization patients complained about mandibular osteomyelitis 3 months after procedures, which recovered after anti-inflammatory treatment for 5 days. One genioglossus stabilization patients appeared hypoglossis bleeding,which stopped after compression. One hyoid suspension patients showed haematoma of submandibular region and cured after incision and drainage. Conclusion Repose system was an effective method, safe, simple, with few complications.

关 键 词：睡眠呼吸暂停 阻塞性 舌 口腔外科手术 耳鼻喉外科手术 

分 类 号：R766[医药卫生—耳鼻咽喉科]