Z形腭成形术治疗重度OSAHS的疗效观察  

Result of Z-palatoplasty for treating severe obstructive sleep apnea hypopnea syndrome

作　　者：王林[1] 刘吉祥[1] 王颖[1] 杨春伟[1] 秦永欣[1] 

机构地区：[1]天津市人民医院耳鼻咽喉头颈外科,天津300121

出　　处：《临床耳鼻咽喉头颈外科杂志》2012年第6期263-265,269,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨Z形腭成形术(ZPP)在治疗重度OSAHS患者的应用及疗效影响因素。方法:32例重度OSAHS的患者,扁桃体均0～Ⅰ度。其中,FriedmanⅡ型、改良Mallampati指数(MMI)舌肥厚Ⅰ～Ⅱ度患者9例单纯行ZPP,FriedmanⅢ型、MMI舌肥厚为Ⅲ～Ⅳ度患者23例行ZPP加舌根等离子打孔消融术。32例患者术后随访1年,观察指标包括:BMI、Epworth嗜睡量表(ESS)评分、AHI、LSaO2及血氧饱和度低于0.90的时间占总睡眠时间百分比(CT90)。结果:手术后AHI从(54.74±20.38)下降到(22.72±18.36),平均LSaO2从(74±12)%上升至(85±14)%,ESS评分从(12.24±5.78)下降到(5.35±3.62),CT90从(31.48±20.15)下降到(15.73±12.29),各相关测量值的变化均具有统计学意义(P<0.01)。疗效评定结果:治愈5例,显效18例,有效4例,无效5例,总有效率为84.4%;按AHI<20且下降>50%计,显效率71.9%。术后暂时性腭咽关闭不全6例,均在术后3个月内恢复正常。结论:ZPP是治疗FriedmanⅡ、Ⅲ型重度OSAHS患者的一种有效、安全的治疗方法。Objective：To investigate the efficacy and related factors of Z-palatoplasty for treating severe obstructive sleep apnea hypopnea syndrome（OSAHS）.Method：Thirty-two severe OSAHS patients with Friedman Ⅱ and Ⅲ oropharyngeal airway had Z-palatoplasty.Twenty-three patients with modified Mallampti Index（MMI） Ⅲ-Ⅳ had coblation tongue channeling（CTC） simultaneously.The patients were followed up for one year post operatively.Result：After operation,the apnea and hypopnea index（AHI） decreased from（54.74±20.38）/h to（22.72±18.36）/h;the lowest artery oxygensaturation（LSaO2） increased from（0.74±0.08） to（0.85±0.14）;the Epworth sleep scale（ESS） decreased from（12.24±5.78） to（5.35±3.62）;the percentage of time with oxyhemoglobin saturation below 0.90（CT90） decreased from（31.48±20.15） to（15.73±12.29）.All of the differences were statistically significant（P〈0.01）.According to related criterion of chinese journal of otorhinalaryngology head and neck surgery in 2009,accumulative excellence rate was 71.9% and accumulative valid rate 84.4%.Six patients had temporary velopharyngeal insufficiency and returned to normal after 3 months.Conclusion：Z-palatoplasty is an effective and safe surgical approach for OSAHS patients with Friedman Ⅱ/Ⅲ.

关 键 词：腭成形术 睡眠呼吸暂停低通气综合征 阻塞性 

分 类 号：R563.8[医药卫生—呼吸系统]