阻塞性睡眠呼吸暂停低通气综合征患者UPPP术后夜间睡眠血氧饱和度的变化  

Transmutation of nocturnal oxygen saturation during sleeping in patients OSAHS after UPPP

作　　者：谢允平[1] 何建平[1] 陈才军[1] 

机构地区：[1]解放军第180医院耳鼻咽喉头颈外科,福建泉州362000

出　　处：《中国耳鼻咽喉颅底外科杂志》2014年第5期413-418,共6页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：南京军区重点基金课题(07Z022)

摘　　要：目的应用便携式血氧仪监测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者悬雍垂腭咽成形术(UPPP)术前及术后第2天到第6天夜间血氧饱和度等相关指标,分析术后短期内血氧饱和度的改善程度和变化趋势。方法根据多导睡眠监测(PSG)结果,对符合OSAHS诊断标准分为轻、中、重3组,并对具有手术指征的52例患者进行UPPP手术,记录其术前及术后第2天至第6天每晚佩戴便携式血氧仪所监测得到的氧减指数(ODI4)、夜间最低血氧饱和度(MiniSO2),血氧饱和度分别低于90%的记录时间占总记录时间的百分比(TS90%)等数据,并进行统计学分析。结果 52例患者术后ESS评分均有不同程度的改善。各组年龄差异无统计学意义(P>0.05),BMI在中度及重度OSAHS组与轻度OSAHS组比较,差异具有统计学意义(P<0.01)。与术前相比,轻、中、重度OSAHS组中术后第2天到第6天ODI4和TS90%差异均具有统计学意义(P<0.05),而MiniSO2差异无统计学意义(P>0.05)。术后第2天到第6天,轻、中、重度OSAHS组内ODI4和TS90%差异均无统计学意义(P>0.05)。轻与中重度OSAHS组间ODI4差异具有统计学意义(P<0.05),TS90%在各组间差异均具有统计学意义(P<0.05)。术前有25例最低血氧饱和度最低值为40%,而术后有20例患者均出现最低血氧饱和度达到40%,部分病例术后有3 d达到此数值。结论尽管OSAHS患者UPPP术后多数血氧饱和度指标较术前有明显改善,但仍有相当部分患者的出现术后重度缺氧情况,存在发现窒息死亡的危险。因此,术后有必要进行连续夜间血氧饱和度监测。Objective To evaluate the short-term postoperative tendency of nocturnal oxygen saturation through monitoring nocturnal oxygen saturation of patients with obstructive sleep apnea-hypopnea syndrome（ OSAHS） at time points before and the 2 nd to 6 th day after uvulopalatopharyngoplasty（ UPPP） by portable oxymeter. Methods 52 patients with OSAHS confirmed by polysomnography（ PSG） were included and divided into mild,moderate and severe group. All the patients underwent UPPP. Oxygen desaturation index（ ODI4）,lowest oxygen saturation（ MiniSO2） and the percentage of the total time with oxygen saturation level lower than 90%（ TS90%） were recorded and compared.Results The subjective symptoms of all the 52 patients were improved after operation. The differences of patients ＇age among the three groups were statistically insignificant（ P〉0. 05）. The differences of patients ＇BMI between the mild group and moderate or severe group were statistically significant（ P〈0. 01） respectively. In the three groups,postoperative ODI4 and TS90% were significantly different from the preoperative ones（ P〈0. 05）. while MiniSO2 were insignificant（ P〉0. 05）. Within each group,the postoperative ODI4 and TS 90 % at the 2 nd to 6 th day after UPPP were insignificantly different（ P〉0. 05）. The ODI4 of the mild group was significantly different from those of moderate to severe group（ P〈0. 05）. The postoperative TS90% were significantly different among the three groups（ P〈0. 05）. Of the 25 patients with preoperative MiniSO2 lower than 40%,MiniSO2 kept lower than 40 % after UPPP,and 9 of them lasted for three days. Conclusions Although majority of OSAHS patients will get better oxygen saturation indexes after UPPP,serious hypoxia may still exist in some patients. Therefore,it is necessary to monitor nocturnal oxygen saturation in recent period after UPPP.

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 悬雍垂腭咽成形术 血氧饱和度 

分 类 号：R766.4[医药卫生—耳鼻咽喉科]