悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停综合症的临床疗效观察
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摘要
目的治疗阻塞性睡眠呼吸暂停低通气综合征(OSAS)的方式很多,悬雍垂腭咽成形术(UPPP)是常见的手术方式。本文的目的主要在观察UPPP手术治疗OSAHS患者的临床疗效,并探讨如何评判阻塞性睡眠呼吸暂停低通气综合征(OSAHS)病的手术指征及围手术期的并发症的发生和预防。
方法对来我科就诊以“打鼾、夜间憋醒”为主诉的病人,根据OSAS诊断标准并符合手术指征的286例的周围阻塞性OSAS病患者进行UPPP手术,根据其术前及术后整夜多导睡眠图检查(PSG)结果做自身对照分析。
结果选择经PSG监测属于周围阻塞性OSAHS病的286例患者,其中轻度鼾症9例,中度鼾症23例,重度鼾症54例,分为三组组。分析三组病人的近期效果、手术范围及并发症。286例OSAS病患者中,术后较术前PSG监测指标(呼吸暂停总时间AI呼吸紊乱指数AHI血氧饱和度SaO2)均有显著性差异,AHl均<15,血氧饱和度SaO2:均>97%,治愈率达93%。
结论UPPP手术是治疗OSAHS病效果较好的手术方法。尤其对于周围阻塞性OSAS病患者效果尤为明显,但是手术有一定的危险和并发症,因此掌握好手术指征和和切除反问非常重要,总之,悬雍垂腭咽成形手术操作简单,值得推广。UPPP的远期效果有待于进一步观察。
Objective There are surgical many ways to cure obstructive sleep apnea syndrome(OSAS),among them uvulopalatopharyngoplasty (UPPP) have been widely used in clinic.This article is arm to observe the therapeutic effect of uvulopalatopharyngoplasty (UPPP) to patients with obstructive sleep apnea-hypopnea syndrome(OSAHS),and to explore a simple method to assess the surgical indications of these patients.
Methods 286 patients with OSAS disease were treated with UPPP ,the results of PSG monitoring of the patients were divided into 2 groups according to these results of pre and post operations.
Results The apnea index (AI)、apnea-hypopnea index (AHI)、SaO2 of postoperation were significantly different from that of preoperation.
Conclusions UPPP is effective for OSAHS .Cases of peripheral obstructive and mixed patients are the best.Other cases cure result of the central site patients are not good.There is certain danger and complication in surgery group,so furthermore UPPP operation is simple and worth to promote.
方法对来我科就诊以“打鼾、夜间憋醒”为主诉的病人,根据OSAS诊断标准并符合手术指征的286例的周围阻塞性OSAS病患者进行UPPP手术,根据其术前及术后整夜多导睡眠图检查(PSG)结果做自身对照分析。
结果选择经PSG监测属于周围阻塞性OSAHS病的286例患者,其中轻度鼾症9例,中度鼾症23例,重度鼾症54例,分为三组组。分析三组病人的近期效果、手术范围及并发症。286例OSAS病患者中,术后较术前PSG监测指标(呼吸暂停总时间AI呼吸紊乱指数AHI血氧饱和度SaO2)均有显著性差异,AHl均<15,血氧饱和度SaO2:均>97%,治愈率达93%。
结论UPPP手术是治疗OSAHS病效果较好的手术方法。尤其对于周围阻塞性OSAS病患者效果尤为明显,但是手术有一定的危险和并发症,因此掌握好手术指征和和切除反问非常重要,总之,悬雍垂腭咽成形手术操作简单,值得推广。UPPP的远期效果有待于进一步观察。
Objective There are surgical many ways to cure obstructive sleep apnea syndrome(OSAS),among them uvulopalatopharyngoplasty (UPPP) have been widely used in clinic.This article is arm to observe the therapeutic effect of uvulopalatopharyngoplasty (UPPP) to patients with obstructive sleep apnea-hypopnea syndrome(OSAHS),and to explore a simple method to assess the surgical indications of these patients.
Methods 286 patients with OSAS disease were treated with UPPP ,the results of PSG monitoring of the patients were divided into 2 groups according to these results of pre and post operations.
Results The apnea index (AI)、apnea-hypopnea index (AHI)、SaO2 of postoperation were significantly different from that of preoperation.
Conclusions UPPP is effective for OSAHS .Cases of peripheral obstructive and mixed patients are the best.Other cases cure result of the central site patients are not good.There is certain danger and complication in surgery group,so furthermore UPPP operation is simple and worth to promote.
引文
[1]孙济治.有关鼾症及阻塞性呼吸暂停综合征疗效评定的意见,临床耳鼻咽喉科杂志,1997;6:28;
[2]中华医学会呼吸病学分会睡眠呼吸疾病学组 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案) [J]中华结核和呼吸杂志,2002,25(4):195～1981;
[3]姜向忠, 姜爱媛, 王嘉祺.老年患者睡眠呼吸暂停综合征特点分析[J]卫生职业教育,2005, 20(8):321;
[4]于进鹏.阻塞性睡眠呼吸暂停与心血管疾病[J],国外医学心血管分册,1992;19:29.
[5]Fazibanks , DNF . Uvulopalatopharyngoplasty corn placations and avoidance atrategies[J].Otolaryngol Head Neck Surg,1990;102:239.
[6]JOHNSON jt , sanders MH . Breathing during sleep immediately after uvulopalatopharyngoplasty[J] .Laryngoscope,1986;96:1236.
[7]Rodenstein DO.Assessment of uvulopalatopharyngoplasty[J].for the treatment of sleep apnea syndrome.Sleep,1992;15:56.
[8]邱蔚六、卢晓峰,睡眠呼吸障碍诊疗进展[J].现代实用医学,2003,4,15(4)201～204
[9]卢晓峰、唐友盛等,计算机辅助设计的定量 UPPP 手术及其评价[J].口腔颌面外科杂志,2003,9,1(3)138～142.
[10] Berry RB et a1.Am J Resp Crit Care M ed,1995;151:1857～ 1861
[11] Lindberg E et a1.Am J Resp Cirt Care Med,1999;159:2024~ 2027
[12]Woodson BT et a1.Laryngoscope,1991;101:1318～ 1322O
[13]Sekosan M et a1.Laryngoscope,1996;106:1O18～102
[14]Gleadhill IC et a1.Am Rev Resp Dis,1991;143;1300～ 1303
[15]Series F et a1.J Clin Invest,1995;95:2O～ 25
[16]Horner RL et a1.J Physiol,1991;436:31～ 44
[17]Ekenvall L et a1.Br J Ind Med,1986;43:825～ 829
[18] Smirne S et a1.Lancet,1991;337:597～ 599
[19] Friberg D et a1.Regulatory Peptides,1997;71:29～ 36
[20] Larsson H et a1. Am Rev Respir Dis,1992;146:12460 1249
[22] Friberg D et a1.Am J Resp Crit Care Med,1998;157:586～ 593
[23] Edstrom L et a1. J Neurol Neurosurg Pszch,1992;55:916～ 920
[1].Lykissas MG, Korompilias AV, Vekris MD.et al.le of erythropoietin in central and peripheral nerve injury Clin Neurol Neurosurg. 2007Oct;109(8):639-44. Epub 2007 Jul.12
[2].Wetmore C.Ckto YH.Pett㈣n RF.Et a1.Proc Nat Acad sci.USA 1991 ,88;9843
[3].Jiang X,Song W Cai Y, et al,VS Chin Jlnt.Med.1999,1:21
[4].Rossi C,Angelucci A,Costantin L,et a1.Brain-derived neurotrophic factor is required for the enhancement of hippocampal neurogenesis following environmental enrichment[J].Eur J Neurosci,2006,24(7):1850—1856.
[5].Rose CR, Blum R, Kafitz KW,et al. From modulator to mediator: rapid effects of BDNF on ion channels[J].Bioessays, 2004,26(11):1185-94.
[6].Huang EJ, Reichardt LF. TRK Receptors: Roles in Neuronal Signal Transduction[J]. Annu Rev Biochem,2003,27:27.
[7].browsky R , Jenkins G , Hannun Y . Neurotrophins inducesphingomyelin hydrolysis[J].J Biol,Chem,1995,279(38):221 35-221 42.
[8].Gaiko MJ.Tessier-lavigne M. Function of an axonaI chemoattractant modulated by metalloprotease activity. Science 2000;289(5483):1365-1367
[9]. Dougherty K D,Dreyfus C F,Black I B.Brain-derived neurotmphic factor in astrocytes , oligedendrocyte , and microglia macrophages after spinal cord injury[J].Neurobiol Di8,2000,7(6):574—585.
[10]. Ikeda O,Murakami M,Ino H,et a1.Efects of BDNF on compression-induced spinal cord injury:BDNF attenuates down regulation of superoxide dismutase expression and promotes up-regulation of myelin basic protein expression [J].Neuropathol Exp Neurol,2002,61:142—15
[11].wu A,Moheni R,Ying Z.A saturated—fat diet aggrawates the outcome of traumatic brain injury on hippocampal plasticity and cognitive function by reducing brain-derived neurotrophic factor.Neuroscience,2003;119:365—375
[12].Li Y, Jia YC, Cui K, Li N et al.Essential role of TRPC channels in the guidance of nerve growth cones by brain-derived neurotrophic factor ature,2005,Apr 14;434(7035);835-8
[13]. Binder DK,Scharfman HE. Brain-derived neurotrophic factor[J].Growth Factors,2004, 22(3): 123-131.
[14]. Rose CR, Blum R, Kafitz KW,et al. From modulator to mediator: rapid effects of BDNF on ion channels[J]. Bioessays,2004,26(11):1185-94.
[15]. Foster E,Risling M,Fried K.TrkB—like immunoreactivity in trigeminal sensorynerve fibers of the rat molar tooth pulp:development and response to nerve in jury.Brain Res,1995;686(2):123～ 133
[16]. Zhang JY, Luo XG, Xian CJ, Liu ZH, Zhou XF.Endogenous BDNF is required for myelination and regeneration of injured sciatic nerve in rodents. Eur J Neurosci. 2000 Dec;12(12):4171-80.
[17]. Foster E,Robertson B,Fried K.TrkB 一 like immunoreactivity in rat dorsal root ganglia following sciatic nerve injury.Brain Res,1994;659(1-2):267～27l
[18] . Cosgaya JM ,Chan JR,Shooter EM .neurotrophin receptor P75NTR as a positive modulator of myelination. Science 2002;298(5596):l245～l248
[19]. Boyd JG,Gordon T.The neurotrophin receptor,trkB and p75,differentially regulate motor axonal regeneration.J Neurobiol,2001,49:314
[20]. Boyd JG,Gordon T.A does-dependent facilitation and inhabitation of peripheral nerve regeneration by brain-derived neurotrophic factor.Eur J Neurosci,2002,15:613
[2]中华医学会呼吸病学分会睡眠呼吸疾病学组 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案) [J]中华结核和呼吸杂志,2002,25(4):195～1981;
[3]姜向忠, 姜爱媛, 王嘉祺.老年患者睡眠呼吸暂停综合征特点分析[J]卫生职业教育,2005, 20(8):321;
[4]于进鹏.阻塞性睡眠呼吸暂停与心血管疾病[J],国外医学心血管分册,1992;19:29.
[5]Fazibanks , DNF . Uvulopalatopharyngoplasty corn placations and avoidance atrategies[J].Otolaryngol Head Neck Surg,1990;102:239.
[6]JOHNSON jt , sanders MH . Breathing during sleep immediately after uvulopalatopharyngoplasty[J] .Laryngoscope,1986;96:1236.
[7]Rodenstein DO.Assessment of uvulopalatopharyngoplasty[J].for the treatment of sleep apnea syndrome.Sleep,1992;15:56.
[8]邱蔚六、卢晓峰,睡眠呼吸障碍诊疗进展[J].现代实用医学,2003,4,15(4)201～204
[9]卢晓峰、唐友盛等,计算机辅助设计的定量 UPPP 手术及其评价[J].口腔颌面外科杂志,2003,9,1(3)138～142.
[10] Berry RB et a1.Am J Resp Crit Care M ed,1995;151:1857～ 1861
[11] Lindberg E et a1.Am J Resp Cirt Care Med,1999;159:2024~ 2027
[12]Woodson BT et a1.Laryngoscope,1991;101:1318～ 1322O
[13]Sekosan M et a1.Laryngoscope,1996;106:1O18～102
[14]Gleadhill IC et a1.Am Rev Resp Dis,1991;143;1300～ 1303
[15]Series F et a1.J Clin Invest,1995;95:2O～ 25
[16]Horner RL et a1.J Physiol,1991;436:31～ 44
[17]Ekenvall L et a1.Br J Ind Med,1986;43:825～ 829
[18] Smirne S et a1.Lancet,1991;337:597～ 599
[19] Friberg D et a1.Regulatory Peptides,1997;71:29～ 36
[20] Larsson H et a1. Am Rev Respir Dis,1992;146:12460 1249
[22] Friberg D et a1.Am J Resp Crit Care Med,1998;157:586～ 593
[23] Edstrom L et a1. J Neurol Neurosurg Pszch,1992;55:916～ 920
[1].Lykissas MG, Korompilias AV, Vekris MD.et al.le of erythropoietin in central and peripheral nerve injury Clin Neurol Neurosurg. 2007Oct;109(8):639-44. Epub 2007 Jul.12
[2].Wetmore C.Ckto YH.Pett㈣n RF.Et a1.Proc Nat Acad sci.USA 1991 ,88;9843
[3].Jiang X,Song W Cai Y, et al,VS Chin Jlnt.Med.1999,1:21
[4].Rossi C,Angelucci A,Costantin L,et a1.Brain-derived neurotrophic factor is required for the enhancement of hippocampal neurogenesis following environmental enrichment[J].Eur J Neurosci,2006,24(7):1850—1856.
[5].Rose CR, Blum R, Kafitz KW,et al. From modulator to mediator: rapid effects of BDNF on ion channels[J].Bioessays, 2004,26(11):1185-94.
[6].Huang EJ, Reichardt LF. TRK Receptors: Roles in Neuronal Signal Transduction[J]. Annu Rev Biochem,2003,27:27.
[7].browsky R , Jenkins G , Hannun Y . Neurotrophins inducesphingomyelin hydrolysis[J].J Biol,Chem,1995,279(38):221 35-221 42.
[8].Gaiko MJ.Tessier-lavigne M. Function of an axonaI chemoattractant modulated by metalloprotease activity. Science 2000;289(5483):1365-1367
[9]. Dougherty K D,Dreyfus C F,Black I B.Brain-derived neurotmphic factor in astrocytes , oligedendrocyte , and microglia macrophages after spinal cord injury[J].Neurobiol Di8,2000,7(6):574—585.
[10]. Ikeda O,Murakami M,Ino H,et a1.Efects of BDNF on compression-induced spinal cord injury:BDNF attenuates down regulation of superoxide dismutase expression and promotes up-regulation of myelin basic protein expression [J].Neuropathol Exp Neurol,2002,61:142—15
[11].wu A,Moheni R,Ying Z.A saturated—fat diet aggrawates the outcome of traumatic brain injury on hippocampal plasticity and cognitive function by reducing brain-derived neurotrophic factor.Neuroscience,2003;119:365—375
[12].Li Y, Jia YC, Cui K, Li N et al.Essential role of TRPC channels in the guidance of nerve growth cones by brain-derived neurotrophic factor ature,2005,Apr 14;434(7035);835-8
[13]. Binder DK,Scharfman HE. Brain-derived neurotrophic factor[J].Growth Factors,2004, 22(3): 123-131.
[14]. Rose CR, Blum R, Kafitz KW,et al. From modulator to mediator: rapid effects of BDNF on ion channels[J]. Bioessays,2004,26(11):1185-94.
[15]. Foster E,Risling M,Fried K.TrkB—like immunoreactivity in trigeminal sensorynerve fibers of the rat molar tooth pulp:development and response to nerve in jury.Brain Res,1995;686(2):123～ 133
[16]. Zhang JY, Luo XG, Xian CJ, Liu ZH, Zhou XF.Endogenous BDNF is required for myelination and regeneration of injured sciatic nerve in rodents. Eur J Neurosci. 2000 Dec;12(12):4171-80.
[17]. Foster E,Robertson B,Fried K.TrkB 一 like immunoreactivity in rat dorsal root ganglia following sciatic nerve injury.Brain Res,1994;659(1-2):267～27l
[18] . Cosgaya JM ,Chan JR,Shooter EM .neurotrophin receptor P75NTR as a positive modulator of myelination. Science 2002;298(5596):l245～l248
[19]. Boyd JG,Gordon T.The neurotrophin receptor,trkB and p75,differentially regulate motor axonal regeneration.J Neurobiol,2001,49:314
[20]. Boyd JG,Gordon T.A does-dependent facilitation and inhabitation of peripheral nerve regeneration by brain-derived neurotrophic factor.Eur J Neurosci,2002,15:613