软腭平面手术联合舌骨悬吊术治疗阻塞性睡眠呼吸暂停综合征效果的Meta分析  

Soft palate surgeries with hyoid bone suspension for obstructive sleep apnea hypopnea syndrome with glossoptosis: a meta-analysis

作　　者：季迪 陈祥 余林[1] JI Di;CHEN Xiang;YU Lin(Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China)

机构地区：[1]重庆医科大学附属第一医院耳鼻咽喉科

出　　处：《山东大学耳鼻喉眼学报》2019年第4期124-130,共7页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：重庆市科技惠民计划项目子课题(cstc2015jcsf10001-02-03)

摘　　要：目的系统评价软腭平面手术联合舌骨悬吊术治疗伴有舌平面阻塞的阻塞性睡眠呼吸暂停综合征( OSAS )患者的疗效。方法采用计算机检索维普、中国知网和Pubmed数据库,按纳入与排除标准选择文献,根据MINORS评价条目评价文献质量,最后提取数据进行定性描述,采用RevMan 5.3软件进行Meta分析。结果共纳入13项研究,共310例患者。病情均为中至重度,随访时间均≥3个月。所选取病例11项为自身前后对照病例,2项为随机对照研究。按照MINORS评价条目评分,2项为低质量研究(总分0~12分),2项为高质量研究(总分19~24分),余下9项为中质量研究(总分13~18分)。11项研究分析了术后呼吸暂停指数(AHI)变化,漏斗图示2项研究位于漏斗底部、不对称,提示存在发表偏倚。2项研究分析了呼吸紊乱指数(RDI)变化。13项研究分析了最低动脉血氧饱和度(LSaO2),漏斗图示4篇文献位于漏斗底部、不对称,提示存在发表偏倚。术后AHI、RDI、LSaO2均较术前改善,AHI 总效应量为45.61,95% CI( 42.48,48.73),P<0.001;RDI总效应量为35.26, 95% CI( 22.47,48.04),P<0.001;LSaO2总效应量为-20.16,95% CI(-24.99,-15.33),P<0.001。Meta分析异质性较高,依次逐个剔除纳入研究进行敏感性分析时,剔除林凌等研究后异质性降低,其他文献则无实质性改变。结论软腭平面手术联合舌骨悬吊术治疗OSAS的研究多为自身前后对照病例,样本量少,质量中等居多;软腭平面手术联合舌骨悬吊术可显著降低伴有舌平面阻塞的OSAS患者的AHI、RDI及提高LSaO2,但需更多证据证实手术效果。Objective To assess the efficacy of soft palate surgeries with hyoid bone suspension for obstructive sleep apnea syndrome(OSAS)with both obstructions of palatopharyngeal plane and hyopharyngeal planes obstructions. Methods An electronic search was conducted on the VIP, CNKI, and Pubmed databases and several studies were selected according to the inclusion and exclusion criteria. Subsequently, the literature quality was evaluated by MINORS and data were extracted to perform qualitative description. Data about effects were meta-analyzed by RevMan 5.3. Results A total of 13 self-controlled trials or RCTs involving 310 patients were included in the present meta-analysis. All the patients presented moderate to severe OSAHS and were followed up for more than 3 months following the surgeries. Most of the trials were self-controlled, whereas two of them were RCTs. According to the MINORS, while two studies represented a low quality research(0-12 points in total), two reported a high quality(19-24 points in total), whereas the remaining nine studies were characterized by a moderate quality(13-18 points in total). Of the 11 studies contrasting the apnea hypopnea index(AHI), 2 were asymmetric at the bottom of the funnel plots, suggesting a publication bias. Furthermore, 2 studies contrasting the respiratory disturbance index(RDI)were present, whereas 13 investigations contrasting the lowest arterial oxygen saturation(LSaO2)were found. Of them, 4 were asymmetric at the bottom of the funnel plots, indicating a publication bias. The meta-analyses described a significant improvement in AHI, RDI, LSaO2, AHI 45.61,95% CI(42.48,48.73),P<0. 001,RDI 35.26,95% CI(22.47,48.04),P<0.001,LSaO2-20.16,95% CI(-24.99,-15.33),P<0.001. A significant heterogeneity was observed in the meta-analysis, while the sensitivity analysis indicated Lin Ling’s result to be the cause. Conclusion Although most studies are moderate quality self-controlled trials, a larger sample size is needed. Soft palate surgeries with hyoid bone suspension are effective

关 键 词：阻塞性睡眠呼吸暂停综合征 舌骨悬吊术 META分析 

分 类 号：R766.7[医药卫生—耳鼻咽喉科]