中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2015年
5期
22-25
,共4页
阻塞性睡眠呼吸暂停低通气综合征%围手术期处理%多平面手术%腭垂腭咽成形术
阻塞性睡眠呼吸暫停低通氣綜閤徵%圍手術期處理%多平麵手術%腭垂腭嚥成形術
조새성수면호흡잠정저통기종합정%위수술기처리%다평면수술%악수악인성형술
Obstructive sleep apnea hypopnea syndrome%Perioperative period%Multi-level surgery%Uvulopalatopharyngoplasty
目的：总结重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）鼻、口咽、喉咽多平面阻塞术前相关检查方法、围手术期处理、手术方式的选择及术后的处理，探讨提高OSAHS疗效、减少复发及预防和降低手术风险的经验。方法：自2012年4月-2013年12月对35例重度OSAHS患者，通过临床常规检查、纤维鼻咽喉镜、X-线投影测量、CBCT气道重建和Alice5多导睡眠监测仪监测（PSG）。在完善围手术期处理后全麻一期完成鼻腔扩容手术、腭垂腭咽成形术（Uvulopalatopharyngoplasty，UPPP）、腭扁桃体切除手术；颏部“开窗”“凸”形或“梯形”截骨前徙颏部及颏舌肌和舌骨上肌群的颏前徙术；舌骨下肌群切断、舌骨悬吊术。术后气管插管维持24~48 h。结果：经过8~20个月随访，35例手术创口均一期愈合，根据疗效评定标准评定，治愈21例，显效10例，有效4例，无效0例，总有效率100%。睡眠呼吸暂停低通气指数（AHI）由术前（59.53±7.74）次/h下降为术后（13.65±4.76）次/h，SaO2由术前（41.97±9.11）%上升为（90.40±4.83）%，最长睡眠呼吸暂停时间由术前（63.14±6.85）s下降为（23.54±6.80）s。结论：存在上气道结构性狭窄的重度OSAHS完善术前检查及围手术期处理，采取同期多平面手术治疗，可明显提高治疗效果且缩短疗程及降低手术风险，经治病例均获得满意疗效。
目的：總結重度阻塞性睡眠呼吸暫停低通氣綜閤徵（OSAHS）鼻、口嚥、喉嚥多平麵阻塞術前相關檢查方法、圍手術期處理、手術方式的選擇及術後的處理，探討提高OSAHS療效、減少複髮及預防和降低手術風險的經驗。方法：自2012年4月-2013年12月對35例重度OSAHS患者，通過臨床常規檢查、纖維鼻嚥喉鏡、X-線投影測量、CBCT氣道重建和Alice5多導睡眠鑑測儀鑑測（PSG）。在完善圍手術期處理後全痳一期完成鼻腔擴容手術、腭垂腭嚥成形術（Uvulopalatopharyngoplasty，UPPP）、腭扁桃體切除手術；頦部“開窗”“凸”形或“梯形”截骨前徙頦部及頦舌肌和舌骨上肌群的頦前徙術；舌骨下肌群切斷、舌骨懸弔術。術後氣管插管維持24~48 h。結果：經過8~20箇月隨訪，35例手術創口均一期愈閤，根據療效評定標準評定，治愈21例，顯效10例，有效4例，無效0例，總有效率100%。睡眠呼吸暫停低通氣指數（AHI）由術前（59.53±7.74）次/h下降為術後（13.65±4.76）次/h，SaO2由術前（41.97±9.11）%上升為（90.40±4.83）%，最長睡眠呼吸暫停時間由術前（63.14±6.85）s下降為（23.54±6.80）s。結論：存在上氣道結構性狹窄的重度OSAHS完善術前檢查及圍手術期處理，採取同期多平麵手術治療，可明顯提高治療效果且縮短療程及降低手術風險，經治病例均穫得滿意療效。
목적：총결중도조새성수면호흡잠정저통기종합정（OSAHS）비、구인、후인다평면조새술전상관검사방법、위수술기처리、수술방식적선택급술후적처리，탐토제고OSAHS료효、감소복발급예방화강저수술풍험적경험。방법：자2012년4월-2013년12월대35례중도OSAHS환자，통과림상상규검사、섬유비인후경、X-선투영측량、CBCT기도중건화Alice5다도수면감측의감측（PSG）。재완선위수술기처리후전마일기완성비강확용수술、악수악인성형술（Uvulopalatopharyngoplasty，UPPP）、악편도체절제수술；해부“개창”“철”형혹“제형”절골전사해부급해설기화설골상기군적해전사술；설골하기군절단、설골현조술。술후기관삽관유지24~48 h。결과：경과8~20개월수방，35례수술창구균일기유합，근거료효평정표준평정，치유21례，현효10례，유효4례，무효0례，총유효솔100%。수면호흡잠정저통기지수（AHI）유술전（59.53±7.74）차/h하강위술후（13.65±4.76）차/h，SaO2유술전（41.97±9.11）%상승위（90.40±4.83）%，최장수면호흡잠정시간유술전（63.14±6.85）s하강위（23.54±6.80）s。결론：존재상기도결구성협착적중도OSAHS완선술전검사급위수술기처리，채취동기다평면수술치료，가명현제고치료효과차축단료정급강저수술풍험，경치병례균획득만의료효。
Objective:To explore the preoperative examination,perioperative treatment,operation treatment, postoperative treatment of multi-level surgery on severe obstructive sleep apnea hypopnea syndrome(OSAHS)though nose,oropharyngeal,laryngeal pharynx,to improve curative effect,reduce the recurrence,prevent and reduce the operation risk of surgery.Method:35 cases who encounter severe obstructive sleep apnea hypopnea syndrome during April 2012 to December 2013 received expansion of the nasal cavity operation,uvulopalatopharyngoplasty,palatine tonsil resection operation,chin"window""convex"shape or"trapezoid"osteotomy advancementgenioplasty and genioglossus and hyoid bone muscleadvancement genioplasty,infrahyoid cut,hyoid suspension,maintain tracheal intubation 24-48h after operation. Result:After 8-20 months of follow up,in 35 cases,all the operations were performed successfully. 21 cases cured,10 cases markedly effective,4 cases effective,the total efficiency was 100%.There were no sleep arousal phenomenon.Mean AHI decreased from(59.53±7.74)time/h preoperative to postoperative(13.65±4.76)time/h, lowest mean oxygen saturation increased from(41.97±9.11)%to(90.40±4.83)%the longest apnea time decreased from(63.14±6.85)s to(23.54±6.80)s.The cases with genioplasty were satisfied with the appearance was improved. Conclusion:The one stage multi-level surgery improve curative effect,reduce the recurrence and the operation risk for the treatment of severe OSAHS.
