锻炼咽腔与颏舌肌治疗阻塞性睡眠呼吸暂停低通气综合征  

Exercise pharynx and genioglossus to treat obstructive sleep apnea and hypopnea syndrome

作　　者：唐世雄[1] 王耀文[1] 卿菁[1] 江远明[1] 陆徐[1] 姚寿国[1] 张旭群[1] 叶贤旺[2] 张杰[2] 黄依琴[3] 

机构地区：[1]宁波市第一医院耳鼻咽喉科,浙江宁波315010 [2]宁波市第一医院影像科 [3]宁波市第一医院睡眠监测室

出　　处：《临床耳鼻咽喉头颈外科杂志》2013年第15期822-826,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：宁波市科技计划社会发展项目(No:2010C50031)

摘　　要：目的:探讨锻炼咽腔与颏舌肌治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的方法及主客观疗效。方法:54例OSAHS患者(锻炼组)自选咽腔与颏舌肌锻炼法治疗,治疗前行Epworth嗜睡评分、PSG监测和320排CT检查上气道,记录其AHI、LSaO2、BMI,腭后区和舌后区的最小矢径和最小横径,计算各壁的顺应性。治疗6个月及12个月后再次行Epworth嗜睡评分、PSG监测与320排CT检查;并与同期悬雍垂腭咽成形术30例(对照1组)、21例因故未做任何治疗者(对照2组)进行比较。采用单因素方差分析比较三者主客观疗效及上气道顺应性变化。结果:锻炼6个月和12个月后复查PSG和320排CT,按2009年OSAHS指南有效率分别为31.48%和44.44%,其中轻中度者6个月有效率为44.74%,12个月有效率为63.16%;Epworth嗜睡评分由平均7.67分降至3.54分和3.25分,AHI由锻炼前平均22.84次/h下降至15.45次/h和13.60次/h(P<0.05),LSaO2由平均74.05%改善至81.18%和81.93%(P<0.01),锻炼前后主客观疗效显著(P<0.05)。对照1组6个月有效率为66.67%,明显高于锻炼组(P<0.05),但12个月有效率为36.67%,与锻炼组比较差异无统计学意义(P>0.05);锻炼组与对照2组比较差异有统计学意义(P<0.01)。320排CT测量各平面咽壁顺应性提示:锻炼12个月后腭后区前后壁顺应性较锻炼前下降(P<0.01),其余各壁顺应性无明显变化。锻炼前后BMI无明显变化(P>0.05)。结论:锻炼咽腔与颏舌肌治疗部分OSAHS患者能改善其症状,无创,无需治疗成本,尤其适用于老年患者和不适宜手术或不愿手术也不愿进行正压通气治疗的轻中度患者,也可作为其他针对OSAHS治疗的补充方法。Objective：To discuss the method and effect of exercising larynx and genioglossus to treat obstructive sleep apnea hypopnea syndrome（OSAHS）. Method： Fifty-four patients who were diagnosed as OSAHS and exercised larynx and genioglossus were defined as treatment group. We took Epworth sleep scale, check patient＇s PSG, and took computer tomography（320CT） before treatment, 6 months and 12 months later. We made a record of AHI, LSaO2, BMI, the shortest sagittal diameter and transverse diameter. Compared with 30 patients who had taken UPPP surgery（control group 1） and the 21 patients without any treatment（control group 2） at the same time. SPSS 10. 0 was used to analyze the data. Result： According to Chinese OSAHS construction in 2009, 6 months and 12 months later, the effective rates of treatment group were 31.48%and 44.44%, among which the effective rates in mild and moderate patients of treatment group were 44.74% and 63.16%. Before treatment the mark of Epworth sleep scale was 7.67, 6 month and 12 month later the marks were 3.54 and 3.25. AHI were up to 15.45 after 6 months and 13.60 after 12 months from 22.84 at the beginning. LSaO2 were up to 81.18% after 6 months and 81.93% after 12 months from 74.05% at the beginning. The effective rate of control group 1 was 66.67 % , and was much higher than the treatment group 6 months later（P〈0.05）. But there was no statistics difference of effective rate between treatment group and control group 1 （36.67 %） after 12 months （P〉0.05）. The effective rates of treatment group were much higher than control group 2 （P〈0.01）. After 12 months, the sagittal wall compliance of retropalatal area was lower（P〈0.01）. There was no significant change of BMI in every group. Conclusion： Exercising larynx and genioglossus is one kind of non-invasive and effective method without payment to treat part of OSAHS patients, especially the patients who is old, without surgical condition, and especially mild and moderate OSAHS patient that do not w

关 键 词：睡眠呼吸暂停低通气综合征 阻塞性 咽腔 颏舌肌 

分 类 号：R563.8[医药卫生—呼吸系统]