天津医药

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等离子辅助手术治疗重度OSAHS患者生活质量的主客观评估

李朝霞1,鲁宏华2,林鹏3   

  1. 1. 天津医科大学一中心临床学院,天津市西青医院耳鼻喉科
    2. 天津市第一中心医院耳鼻咽喉头颈外科、天津市耳鼻咽喉研究所
    3. 天津医科大学一中心临床学院
  • 收稿日期:2013-01-05 修回日期:2013-07-18 出版日期:2013-11-15 发布日期:2013-11-15
  • 通讯作者: 李朝霞

Subjective and Objective Assessment of Quality of Life for Coblation-assisting Operation in Patients with Severe OSAHS

LI Zhao xia1,LU Hong hua2,LIN Peng 3   

  1. 1. The First Center Clinic College, Tianjin Medical University,Department ofOtorhinolaryngology, Tianjin Xiqing Hospital
    2. Department of Otorhinolaryngology Head andNeck Surgery, Tianjin First Central Hospital, Otorhinolaryngology Institute of Tianjin
    3. The First Center Clinic College, Tianjin Medical University
  • Received:2013-01-05 Revised:2013-07-18 Published:2013-11-15 Online:2013-11-15
  • Contact: LI Zhao xia

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摘要：

【摘要】 目的   评估低温等离子辅助改良悬雍垂腭咽成形术（H-UPPP）+舌根淋巴组织切除术+舌体打孔消融术（CCT）联合治疗重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者生活质量的改善程度，并与单纯行H-UPPP手术疗效进行比较。  方法   重度OSAHS患者81例，其中治疗组42例采用低温等离子辅助H-UPPP+舌根淋巴组织切除术+CCT治疗，对照组39例行H-UPPP手术，记录2组患者术前及术后6个月的睡眠呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2），采用魁北克睡眠问卷（QSQ）和Epworth嗜睡量表（ESS）评估患者生活质量并进行比较。  结果   治疗组患者术后各项指标较术前均有明显改善（P < 0.01），手术总有效率优于对照组（83.3% vs 12.8%，χ2=40.225，P＜0.01）。治疗组QSQ中白天嗜睡（76.2% vs 25.6%）、夜间症状（54.8% vs 5.1%）、白天症状（71.4% vs 10.2%）、情绪（54.8% vs 2.5%）及社会交往（50.0% vs 2.5%）5个维度以及总分（57.1% vs 7.7%）的术后总改善率均优于对照组；治疗组术后ESS中重度的比例下降至23.8%，优于对照组的51.3%。  结论 采用低温等离子辅助H-UPPP+舌根淋巴组织切除术+CCT治疗重度OSAHS可取得较好的疗效，患者的生活质量也能得到明显改善。 

关键词: 睡眠呼吸暂停, 阻塞性, 悬雍垂, 导管消融术, 肌电描记术, 多道睡眠描记术, 生活质量, 外科手术

Abstract:

[Abstract]   Objective   To evaluate the subjective and objective improvement of quality of life in patients with lowtemperature plasma- assisted modified uvulopalatopharyngoplasty (H- UPPP) combined with lymphoidectomy in radix lin?guae and coblation-channeling of the tongue(CCT) treating for severe obstructive sleep apnea hypopnea syndrome (OSAHS)，and compare the surgical efficacy with that of H-UPPP.  Methods   A total of81patients with severe OSAHS were divided into treatment group (n=42) and control group (n=39). Treatment group underwent the low-temperature plasma-assisted HUPPP combining lymphoidectomy in radix linguae and CCT，and control group underwent H-UPPP treatment. The apnea hypopnea index (AHI), the lowest saturation of arterial oxygen (LSaO2) and Quebec sleep questionnaire (QSQ) and Epworthsleepiness scale (ESS) before operation and6-month after operation were recorded and compared between two groups.  Results   All of detection indicators were significantly improved after operation in treatment group (P<0.01). The total surgicalefficacy was significantly higher in treatment group than that of control group (83.3%vs12.8%，χ2=40.225，P＜0.01). The total improvement rate of five dimensions in QSQ such as daytime sleepiness symptoms (76.2%vs25.6%), signs during the day(71.4%vs10.2%) and night (54.8%vs5.1%), emotion (54.8%vs2.5%), ability of social intercourse (50.0%vs2.5%) and thetotal score (57.1%vs7.7%) after operation were significantly higher in treatment group than those of control group. The severe indexes of ESS decreased to23.8% after operation in treatment group than those of control group (51.3%).   Conclusion    Low-temperature plasma-assisted H-UPPP combined with lymphoidectomy in radix linguae and CCT is effective in patients with severe OSAHS, which can also improve the quality of life postoperatively.

Key words: sleep apnea, obstructive, uvula, catheter ablation, electromyography, polysomnography, quality of life, 外科手术