改良悬雍垂腭咽成形术长期疗效的主观评价  

Long-term outcome of Han-uvulopalatopharyngoplasty with uvula reserved

作　　者：叶京英[1] 李彦如[1] 李鹏鲲[2] 丁秀[1] 高丽敏[2] 尹国平[1] 王伯轩[1] 董佳佳[1] 王军[1] 杨庆文[1] 韩德民[1,3] 

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耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]北京中医药大学统计学教研室,北京100029 [3]北京市耳鼻咽喉科研究所,北京100005

出　　处：《中国耳鼻咽喉头颈外科》2011年第2期90-94,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金(30730100);北京市自然科学基金重大项目(7100002)联合资助

摘　　要：目的评价保留悬雍垂的改良悬雍垂腭咽成形术(Han-uvulopalatopharyngoplasty,H-UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者术后5年的主观疗效改善程度。方法回顾性队列研究。电话问卷随访2165例确诊5年及以上的OSAHS患者(呼吸暂停低通气指数≥5次/h),分为未治疗组、H-UPPP组和持续正压通气(CPAP)组。评估患者确诊时和随访时主观症状的评分,获得各项评分的改变量。对比手术治疗前、后评分改变量并比较3组患者上述症状改善量的差异。对接受治疗者,主观评价该治疗措施消除OSAHS对生活不利影响的视觉模拟量表(visual analogue scale,VAS)评分,10分为满分,表示完全消除OSAHS对生活不利影响,对比组间VAS评分的差异。结果成功随访744例(34.4%)患者,平均随访时间5.24年。H-UPPP治疗194例(26.1%),CPAP治疗125例(16.8%),未治疗者320例(43.0%),其他治疗方式105例。H-UPPP治疗者与治疗前相比,打鼾较术前减轻或消失者占84.7%;夜间呼吸暂停较术前减轻或消失的患者占70.2%;149例(76.8%)患者的Epworth嗜睡量表(Epworth sleepiness score,ESS)评分较术前下降,平均下降4.5[1.0;9.0];在术前有嗜睡(ESS评分≥9分)的83例手术患者中,69例(83.1%)术后嗜睡症状消失;白天精力和工作能力改善者占75.7%;晨起口干改善者占63.2%。176例手术患者参与评分,中位数8[7;9],评分≥5分的患者占92.0%;H-UPPP与CPAP治疗患者相比,VAS评分(8[7;9]vs 8[8;9],Z=-1.881,P=0.06),白天困意程度不存在差异。CPAP与H-UPPP治疗相比,ESS评分(Z=-3.277,P=0.001),晨起口干(Z=-3.474,P=0.001),精力和注意力(Z=-3.071,P=0.001)的改善程度较高。结论 H-UPPP治疗OSAHS术后5年ESS评分,打鼾、嗜睡、晨起口干、夜间呼吸暂停较较治疗前明显改善。OBJECTIVE To measure long-term symptom improvement following revised uvulopalatopharyngoplasty（H-UPPP）,compared with continuse positive airway pressure（CPAP）therapy in patients with obstructive sleep apnea（OSA）.METHODS Retrospective cohort study in 2165 subjects [744 subjects（34.4%）finally completed the follow up].Simutanceously adult patients with OSA underwent H-UPPP（n=194）,had CPAP（n=125）,or untreated（n=320）were followed by questionnaire at 5.24 years after therapy.They were asked to repeat to grade the questionnaires and Epworth sleepiness scale（ESS）.Visual analogue scale（VAS）was used to evaluate the effect of treatment.RESULTS 84.7% subjects in H-UPPP group reported improvement in snoring,while 70.2% reported improvement in notable nocturnal apneas;In 149 cases（76.8%）the ESS score decreased compared with preoperative value,with a median of 4.5 points[1.0;9.0];ESS score dropped blow 9 points in 69/83（83.1%） subjects who had postoperative ESS score over 9 points.75.7% subjects had improved energy and attention during the day;63.2% subjects had improved dry mouth.The median of VAS score for treatment effect of H-UPPP was 8[7;9]（n=176）while 92.0% had an VAS score≥ 5.No significant difference was seen between surgical group and CPAP controls in VAS score（8[7;9] vs 8[8;9],Z=-1.881,P=0.06）.Either was the symptom of exessive daytime sleepiness.greater improvement was achived by CPAP group in ESS score（Z=-3.277,P=0.001）,dry mouth in the morning（Z=-3.474,P=0.001）as well as energy and attention（Z=-3.071,P=0.001）.CONCLUSION Symptoms were improved of snoring,sleepiness,dry mouth,night respiratory arrest,energy during the day as well as ESS score five years after H-UPPP in patient with OSA.

关 键 词：睡眠呼吸暂停 阻塞性 连续气道正压通气随访研究 改良悬雍垂腭咽成形术 

分 类 号：R766[医药卫生—耳鼻咽喉科]