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目的探讨重症阻塞性睡眠呼吸暂停低通气综合征的治疗方法,提高临床疗效和减少并发症。方法对15例经多导睡眠监测仪监测确认为重症阻塞性睡眠呼吸暂停低通气综合征患者术前进行为期1W的持续正压通气,再进行改良腭咽成形和等离子软腭、悬雍垂、舌根及下鼻甲消融,扩大咽气道。结果术后随访3~6m,无明显并发症,所有患者均取得了满意效果。患者射频治疗前和治疗12W后多导睡眠参数比较显示治疗后Ⅰ+Ⅱ期睡眠时间明显缩短,Ⅲ+Ⅳ期睡眠时间明显延长,睡眠效率及最低脉氧饱和度(LspO2)均显著提高(P<0.01);呼吸暂停低通气指数减低及打鼾时间缩短均较治疗前相比差异非常显著(P<0.01)。患者射频治疗12W后软腭长主及悬雍垂度的缩短及鼾声评级的降低均较治疗前相差非常显著(P<0.01)。Epworth嗜睡程度评分亦较治疗前明显降低(P<0.01)。结论持续正压通气、腭咽成形术和等离子消融综合治疗阻塞性睡眠呼吸暂停低通气综合征具有较好的近期疗效,且方便、安全、微创、恢复快,无不良反应,有较好的发展前景,值得推广应用。
Objective To investigate the treatment of severe obstructive sleep apnea-hypopnea syndrome, improve clinical efficacy and reduce complications. Methods Fifteen patients with severe obstructive sleep apnea-hypopnea syndrome who were monitored by polysomnography were enrolled in the study. The patients underwent continuous positive pressure ventilation of 1W before surgery, followed by modified velopharyngeal and plasma soft palate, uvula and tongue base And lower turbinate ablation, expand the pharyngeal airway. Results The patients were followed up for 3 to 6 months without any significant complications. All patients achieved satisfactory results. Comparisons of polysomnography parameters before and 12h after radiofrequency ablation showed that the duration of I + II sleep was significantly shortened, the duration of sleep in stage III + IV was prolonged, and the sleep efficiency and the lowest pulse oxygen saturation (LspO2) were significantly increased (P <0.01). The decrease of apnea-hypopnea index and snore duration were significantly different from before treatment (P <0.01). The shortening of soft palate length and uvula degree and the decrease of snoring rating of patients after radiofrequency treatment for 12W were significantly different from those before treatment (P <0.01). Epworth sleepiness score was also significantly lower than before treatment (P <0.01). CONCLUSIONS: Continuous positive pressure ventilation, velopharyngeal angioplasty and plasma ablation in the treatment of obstructive sleep apnea-hypopnea syndrome have a good short-term curative effect and are convenient, safe, minimally invasive, rapid recovery, no adverse reactions, and have better Development prospects, it is worth promoting application.