摘要
目的：探讨重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的分度诊断和治疗方案，提高手术安全性和疗效。方法：将随访资料完整、AHI〉40的患者分成重度（AHI〉40～〈65）和极重度（AHI≥65）2个组。全部患者经术前CPAP治疗后均在全身麻醉下行保留悬雍垂的改良悬雍垂腭咽成形术（UPPP），全身麻醉前行气管切开者，鼻部、腭咽部手术同期进行，舌根部手术分期进行；未行气管切开者，鼻部、舌根部手术分期进行。结果：重度组198例中，169例全身状态可、手术耐受性好的患者未行气管切开，另29例行气管切开，气管切开率为14．6％（29／198），治愈9例（4．5％），显效137例（69．2％），有效24例（12．1％），无效28例（14．1％），总有效率85．9％。极重度组58例患者术前均行预防性气管切开，气管切开率为100％（58／58），显效25例（43．1％），有效12例（20．7％），无效21例（36．2％），总有效率为63．8％。术后3周，悬雍垂长度由术前的（4．89±0．58）cm缩短为（3．12±0．46）cm（P〈0．05）。术后总的并发症发生率为3．5％。结论：将重度OSAHS进一步分为重度和极重度对临床有一定的指导意义。重度患者中大部分患者经积极正确的围术期处理后，可以避免气管切开。而对于极重度患者，建议术前尽量行预防性气管切开。保留悬雍垂的改良UPPP，保留了悬雍垂的生理功能，减少了手术并发症的发生，减轻了手术痛苦，改善了生活质量。
Objective：To explore the diagnose and treatment of severe OSAHS with distinction of different extent. Method： All 256 severe OSAHS patients were divided into two groups according to sleep apnea hypopnea index （AHI）： group one （severe group）, 40〈AHI〈65; group two （extra severe group）, AHI≥65. All patients were underwent CPAP treatment for at least one week before modified UPPP in general anesthesia. UPPP and （or） nasal septum plasty or partial inferior turbinectomy were operated in one stage if tracheotomy was conducted. If tracheotomy were not conducted, the patient was only accepted UPPP under general anesthesia. The other operations to remove the multi block factors were operated in local anesthesia. Result： In 198 group one patients, there were 169 patients accepted UPPP in general anesthesia without tracheotomy, the other 29 patients were conducted with tracheotomy. The tracheotomy rate was 14.6%. The total effective cure rate was 85.9%. In all 58 group two patients, tracheotomy were conducted, and the total effective cure rate was 63.8%. The complication rate of all the two groups＇ patients was 3.5%. After three weeks,the uvulas decurtated from（4.89±0.58）cm to （3.12± 0.46） cm. Conclusion, It is important to divide the severe OSAHS patients into severe group and extra severe group because the treatments were different. Not all the severe OSAHS patients need tracheotomy. There were advantages to retain the uvula in UPPP and patients＇ life quality was improved with uvula reserved.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2007年第11期507-509,共3页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
基金
湖南省卫生厅资助项目(No:B2006-149)
