铒激光微创治疗阻塞性睡眠呼吸暂停低通气综合征的近期疗效观察  

Nonsurgical minimally invasive Er:YAG laser in obstructive sleep apnea hypopnea syndrome treatment

作　　者：冯岩[1] 高和[2] 李冬霞[1] 栗洪师[1] 

机构地区：[1]空军总医院口腔科,北京100142 [2]空军总医院睡眠中心,北京100142

出　　处：《空军医学杂志》2016年第2期130-132,共3页Medical Journal of Air Force

基　　金：首都临床特色应用研究与成果推广项目(Z151100004015210)

摘　　要：目的探讨应用铒(Er:YAG)激光微创治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea svndrome,OSAHS)的临床疗效。方法选取75例轻度OSAHS患者:治疗前完成多导睡眠仪监测(polysomnography,PSG),5<低通气指数(apnea hypopnea index,AHI)<20;随机分为试验组(Er:YAG治疗组,依据照射激光累计脉冲数值分别为4 000、8 000计数单位亚组;25例/亚组)和对照组(25例,患者治疗步骤除了口腔Er:YAG仪器不激发脉冲能量外,其余操作过程同Er:YAG治疗组程序)。应用铒激光(FOTONA Fideli,德国;输出平均功率:5.75 W,脉宽:320μm,频率:10 Hz,单光斑直径1 mm),距离口腔黏膜表面1 mm,自腭小凹横断面向延伸后至悬雍垂根部,两侧伸展至咽腭弓基部平面黏膜区域,匀速平行移动手具头,3 cm^2/min,计数相应值后停止治疗,2周和5周后分别行第2、3次治疗。疗程结束12周后行PSG检测和鼾症改善量表收集。结果分别和铒激光治疗4 000计数单位组、对照组比较,铒激光治疗8 000计数单位组治疗后12周总有效率为84.6%,鼾症改善率为57.2%,患者术中、术后无疼痛感特点,术后依从性好;总有效率有显著升高,组间比较差异有统计学意义(Z=-2.036,P<0.05;Z=-4.155,P<0.01);和对照组比较,试验组铒激光治疗4 000计数单位组6周总有效率为16.1%,鼾症改善率为18.4%,总有效率降低不显著(Z=-1.034,P>0.05)。结论应用铒激光微创治疗轻度OSAHS患者疗效明显。Objective To explore 12 weeks clinical experience performing the Er：YAG laser treatment on patients with obstructive sleep apnea hypopnea syndrome（OSAHS）.Method The Lase treatment was based on a minimally invasive photo-thermal effect by using Er：YAG laser light on oral mucosa.In a period of 12 weeks,75 patients having OSAHS syndrome symptoms were treated.All patients received three sessions of the Er：YAG laser treatment（Er：YAG treatment group：8 000,4 000 units of subgroup according to the cumulative pulse laser pulse value was;control group：0 units of subgroup）.ErYAG laser（fotona Fidelis,Germany;output average power：5.75 W,pulse width：32 μm,frequency：10 Hz,single light spot 1 mm in diameter） was applied to the distance of oral mucosal surface of 1 mm,transection of palatal pits for extension to the roots of uvula.Both sides of the stretched to pharyngeal mucosa region of palatal base flat surface,uniform parallel moving hand head,3 cm^2/min,the corresponding count value were treated,2 weeks and 5 weeks respectively after the 2nd and 3rd time treatment.PSG detection and improvement of snoring scale collection was performed at 12 weeks after laser treatment.Result Compared with ErYAG laser 4 000 counting unit group and the control group,the snoring improvement rate in patients in the 8 000 units treatment group improved by 57.2%and the total efficiency improved by 84.6%respectively at 12 weeks after laser treatment（Z=- 2.036,P〈0.05;Z=- 4.155,P〈0.01）;compared with Er：YAG laser 4 000 counting unit group,the snoring improvement rate in patients in the the control group improved by18.4%and the total efficiency improved by 16.1%respectively at 12 weeks after laser treatment（Z=- 1.034,P〈0.05）.Conclusion The Er：YAG laser method has been found to be an effective,minimally invasive and safe method for treating patients with OSAHS.

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 铒激光 激光治疗 

分 类 号：R766.4[医药卫生—耳鼻咽喉科]