【摘要】 目的探讨不同时间抑酸治疗对阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome, OSAHS）并咽喉反流患者（laryngopharyngeal reflux disease, LPRD）行悬雍垂腭咽成形术疗效的影响。方法 63例OSAHS并LPRD的患者随机分为3组:观察1组21例,入院前口服8周的质子泵抑制剂（耐信）和促胃肠动力药（莫沙比利）;观察2组21例,入院当天开始口服予质子泵抑制剂和促胃肠动力药（药品及剂量同观察1组）,直至出院后继续用药至8周;对照组21例,入院时给与安慰剂（淀粉片,外观同耐信）口服（疗程及用法同观察2组）。比较三组患者抑酸治疗前、后及观察组出院8周时的睡眠呼吸暂停低通气指数（apnea-hypopnea index, AHI）、血氧饱和度（SaO₂）、嗜睡量表评分（Epworth sleepiness scale, ESS）、反流症状评分（the reflux symptom index, RSI）和反流体征评分（the reflux finding score, RFS）;观察三组术后第1、7和14天的咽痛主观评分（visual analogue scale, VAS）,术中出血量和手术时间,并发症发生率和疗效。结果抑酸治疗前三组AHI、SaO₂、ESS、RSI和RFS评分差异均无统计学意义（P>0.05）;抑酸治疗后三组AHI、ESS、RSI和RFS检测及评估结果均优于治疗前（均为P<0.05）。出院8周时,同组比较,三组AHI、ESS、RSI和RFS结果均低于治疗前,观察1组AHI、SaO₂检测结果及ESS、RSI、RFS评分均优于另外两组,观察2组优于对照组（P<0.05）。术后第1、7、14天,观察1组咽痛VAS评分均低于观察2组和对照组,观察2组低于对照组（P<0.05）;观察1组术中出血量（42.13±11.32 ml）和手术时间（74.24±12.37 min）均优于另外两组（分别为54.26±12.36 ml、55.31±12.45 min和86.31±14.49 ml, 87.28±14.37 min）（均为P<0.05）;观察1组术后出血发生率（0%）低于另外两组（分别为23.80%、28.57%）（P<0.05）;观察1组治愈率（55.56%）高于观察组和对照组（分别为23.81%、4.76%）,观察1组和观察2组总有效率（分别为94.44%、71.43%）高于对照组（57.14%）（P<0.05）。结论对于OSAHS并LPRD行悬雍垂腭咽成形术的患者,手术前给予8周抑酸治疗,有利于降低术后咽痛程度,降低术后出血发生率和提高临床疗效。更多还原

【Abstract】 Objective To study the effect of different period of antireflux on patients with obstructive sleep apnea hypopnea syndrome（OSAHS） and laryngopharyngeal reflux disease（LPRD）underwent uvulopalatopharyngoplasty.Methods Sixty-three patients with OSAHS and LPRD in our hospital from Jan 2016 to Jun 2020 were selected and randomly divided into three groups with 21 cases in each group. The observation 1 group was given proton pump inhibitor（nexium, 40 mg, qd） and mosapride（3 times a day, 1 capsule once a time） for 8 weeks before admission, and the observation 2 group was given proton pump inhibitor（nexium, 40 mg, qd） and mosapride（1 capsule, 3 times a day） for 8 weeks at admission to hosiptal.The control group was given placebo oral treatment at admission. The AHI, SaO₂, ESS, RSI and RFS scores of the three groups were compared among the three groups at the time of T₁（pre-treatment）,T₂（post-treatment）and T₃（8 weeks after treatment）, VAS scores of sore throat on the first day, the seventh day and the fourteenth day after operation, the amount of bleeding and operation time in the three groups, the incidence of complications and the clinical efficacy after 8 weeks of hospitalization in the three groups were collected and compared. Results There were no significant differences in AHI, SaO₂, ESS, RSI and RFS scores among the three groups at the time of T1（P>0.05）. At the time of T2, AHI, SaO₂, ESS, RSI and RFS scores in observation 1 group were better than those before treatment（P<0.05）. At the time of T3, the scores of AHI, ESS, SaO₂, RSI and RFS in the three groups were lower than those before treatment, the scores of AHI, ESS, SaO₂, RSI and RFS in observation 1 group were better than those in the other two groups, and those in observation 2 group were better than those in control group（P<0.05）.The VAS scores of pharyngeal pain in observation 1 group was lower than that in other two groups on the 1 st, 7 th and 14 th day after operation, and the VAS score of observation 2 group was lower than that of control group on the same days（P<0.05）. The intraoperative blood loss（42.13±11.32 ml） and operation time（74.24±12.37 min） in observation 1 group were better than those（54.26±12.36,55.31±12.45 ml）,（86.31±14.49,87.28±14.37 min） in the other two groups（P<0.05）, and the incidence of postoperative bleeding in observation 1 group（0%） was lower than those of in the other two groups（23.80%,28.57%）（P<0.05）. There was no significant difference in the number of fever cases among the three groups and no local infection or lung disease occurred in the three groups（P>0.05）. The cure rate of observation 1 group（55.56%） was better than those of in the other two groups（23.81%,4.76%）.The cure rate of observation 2 group（23.81%）was better than that of control group（4.76%）, the total effective rate of observation 1 group（94.44%） and observation 2 group（71.43%） was better than that of control group（57.14%）, the differences were all statistically significant（P<0.05）.Conclusion For patients with OSAHS and LPRD undergoing uvulopalatopharyngoplasty, anti-reflux therapy for 8 weeks before admission can further improve the clinical symptoms, reduce the degree and duration of postoperative sore throat and the incidence of postoperative bleeding and improve the clinical efficacy.更多还原