重度OSAHS上气道手术与CPAP压力滴定相关性研究初探  

Correlation between upper airway surgery and continuous positive airway pressure titration in severe obstructive sleep apnea hypopnea syndrom

作　　者：蒋振华[1] 王杰[1] 董钏[1] 刘国旗[1] 邓伟[1] 张珍[1] 柳庆君[1] 

机构地区：[1]四川省绵阳市中心医院耳鼻咽喉头颈外科,绵阳621000

出　　处：《中国眼耳鼻喉科杂志》2012年第6期360-363,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：四川省科技厅资助项目(09-06-0701077)

摘　　要：目的初步探讨重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者手术前后持续正压通气(CPAP)压力滴定的变化及其影响因素。方法经多道睡眠监测(PSG)确诊的重度OSAHS患者42例,呼吸暂停低通气指数(AHI)>30次/h,经电子鼻咽喉镜检查结合Müller试验、上气道CT检查等确定存在鼻腔、鼻咽、腭咽及舌咽两平面或以上阻塞。所有患者术前先行经鼻CPAP(nCPAP)治疗5～7d;然后同期行悬雍重腭咽成形术联合鼻腔、舌根、下咽以及喉部的多平面手术。分别比较术前与术后1个月、6个月的CPAP平均压力值及最大值、体质量指数(BMI)、AHI、最低血氧饱和度(LSaO2)、Epworth嗜睡量表(ESS)的变化。结果 42例患者术后1个月及6个月,CPAP平均压力值从(14.5±2.4)cm2H2O分别下降到(7.6±2.2)cm2H2O和(5.6±2.8)cm2H2O;CPAP最高压力值从(15.6±3.2)cm2H2O分别下降到(8.2±2.8)cm2H2O及(6.2±1.5)cm2H2O;BMI从(29.2±2.8)kg/m2分别下降到(22.4±3.2)kg/m2及(21.4±2.5)kg/m2;AHI从(62.4±15.2)次/h分别下降到(25.4±13.3)次/h及(20.3±10.3)次/h;LSaO2min从65.5%±12.3%分别上升至75.3%±13.4%及80.3%±12.2%;ESS从17.8±5.7分别下降到12.3±2.6及10.3±2.2。上述各参数术前分别与术后1个月及6个月比较,差异均有统计学意义(P<0.01)。结论重度OSAHS患者手术前后CPAP压力滴定值有明显变化,术后CPAP压力值低于术前。Objective To investigate the pre- and postoperative continuous positive airway pressure （CPAP） titration in severe obstructive sleep apnea hypopnea syndrome （OSAHS） patients and the related influencing factors. Methods Forty-two patients of severe OSAHS confirmed by polysomnography,with apnea hypopnea index （AHI） 〉 30/h were concluded in the study. These patients were confirmed with two or more obstructive planes such as nasal pharynx, palatopharynx and glossopharyngeum tested by electronic nasopharyngoscope combined with Mailer examination and upper airway CT test. All patients were treated with nasal CPAP （nCPAP） for 5 - 7 days before the operation. Multiple planes surgery was performed in all cases. The CPAP value, the body mass index （BMI）, AHI, the lowest oxygen saturation （ LSaO2 ） and Epworth sleepy scale （ESS） was compared before and 1 month, 6 months after the surgery. Results The average CPAP value decreased from preoperative （ 14.5 ± 2.4） cm2 H20 to （7.6 ± 2.2） cm2 H20 1 month and （ 5.6 ± 2.8） cm2 H2O 6 months postoperatively; the maximum CPAP value decreased from（ 15.6 ± 3.2） cm2 H2O to （8.2 ± 2.8） cm2 H20 and （6.2 ± 1.5 ）em2 HE O ; BMI decreased from （29.2 ± 2.8 ） kg/m2 to （22.4 ± 3.2） kg/m2 and （21.4±2.5） kg/m2; AHI decreased from （62.4 ± 15.2）/h to （25.4 ± 13.3）/h and （20.3 ± 10.3） /h; LSaO2 rised from 65.5% ± 12.3% to 75.3% ± 13.4% and 80.3% ± 12.2% ; ESS decreased from 17.8 ± 5.7 to 12.3 ± 2.6 and 10.3 ± 2.2. There were significant differences in the above parameters 1 month and 6 months after the surgery compared with the preoperative values （P 〈 0.01 ）. Conclusions There was obvious difference in CPAP value pre- and postoperatively in severe OSAHS patients with the CPAP value decreased after the surgery.

关 键 词：睡眠呼吸暂停低通气综合征 阻塞性 多平面手术 持续正压通气 

分 类 号：R766[医药卫生—耳鼻咽喉科]