【摘要】 目的:比较激光辅助性悬雍垂腭咽成形术和口腔矫治器及经鼻持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者的近期及远期治疗效果。方法:①选择1998-04/2002-10在江西省人民医院门诊就诊的中度阻塞性睡眠呼吸暂停低通气综合征患者286例。②对患者分别进行激光辅助性悬雍垂腭咽成形术、口腔矫治器和经鼻持续气道正压通气治疗。患者对治疗方案均知情同意。③疗效分3级:呼吸暂停、打鼾,临床症状(白天嗜睡,疲乏等)消失或基本消失,睡眠呼吸暂停低通气指数下降75%,或低通气指数低于10次/h为显效;呼吸暂停,打鼾,临床症状有较明显减轻,低通气指数下降75%～25%为有效;呼吸暂停,打鼾,临床症状改善不明显或加重,低通气指数下降低于25%为无效。④治疗效果评估采用患者填写调查表(内容主要有睡眠鼾声、呼吸暂停、晨起口干、白天嗜睡)和医师评价形式完成。调查表每项目了解3个时间段情况,治疗前、治疗后2周内(近期),治疗2年后(远期)。⑤计数资料的比较采用χ2检验。结果:中度阻塞性睡眠呼吸暂停低通气综合征患者286例中配合调查的117例纳入结果分析。其中经激光辅助性悬雍垂腭咽成形术治疗48例,经口腔矫治器治疗26例,经鼻持续气道正压通气治疗43例。①近期疗效:激光辅助性悬雍垂腭咽成形术治疗有效率96%(46/48),经口腔矫治器治疗有效率100%(26/26),经鼻持续气道正压通气治疗有效率100%(43/43),3种治疗方法近期有效率相近(P>0.05)。②远期疗效:经口腔矫治器治疗和经鼻持续气道正压通气治疗有效率明显高于激光辅助性悬雍垂腭咽成形术治疗[100%(43/43),92%(24/26),54%(26/48),χ2=11.196,31.344,P<0.01],经鼻持续气道正压通气治疗显效率明显高于经口腔矫治器治疗[86%(37/43),23%(6/26),χ2=27.36P<0.01]。结论:治疗中度阻塞性睡眠呼吸暂停低通气综合征效果最好的是经鼻持续气道正压通气,其次是经口腔矫治器治疗,远期疗效相对最差的是激光辅助性悬雍垂腭咽成形术。更多还原

【Abstract】 AIM To compare the short-term and long-term therapeutic efficacy of laser assited uvulopalatopharyngoplastyLAUP oral appliance OAand nasal continuous positive airway pressurenCPAPin the treatment of obstructive sleep apnea-hypopnea syndrome OSAHS. METHODS ① 286 patients with moderate obstructive sleep apnea-hypopnea syndrome who were treated at the out-patient clinic of Jiangxi People’s Hospital from April 1998 to October 2002 were selected. ② The patients were treated with LAUP OA and nCPAP respectively. They all knew the fact of the therapy program and agreed. ③ The 3-grade effect The symptom of apnea snoring and clinical symptom drowsiness in daytime weary etc. disappeared or nearly disappeared and the apnea-hypopnea index AHI decreased about 75% or the AHI less than 10 times per hour was significant The apnea snoring and clinical symptom had significantly decreased and the AHI descreased 75%-25% was effective The apnea snoring and clinical symptom did not have obvious amelioration or became severe and the AHI decreased 25% was inefficiency. ④ The therapeutic efficacy was assessed by the self-filling questionnaire including snoring apnea dry mouth in the morning drowsiness in the daytime and physician evaluation. Every item in the questionnaire was known about 3-period condition pretreatment within 2 week after treatment short-term 2 years after treatment long-term. ④ The enumeration data was compared by χ2 test. RESULTS 117 patients who cooperated the investigation from the 285 patients with OSAHS were involved in the result analysis among them 48 patients by LAUP 26 patients by OA and 43 patients by nCPAP. ① Short-term effect The efficiency of LAUP was 96% (46/48) efficiency of OA 100% 26/26 and nCPAP 100%43/43 and the short-term efficiency of the three therapy methods was close (P > 0.05). ② Long-term effect The efficiencies of OA therapy and nCPAP therapy were significantly higher than that of LAUP therapy 100%(43/43), 92% (24/26), 54% (26/48),χ2=11.196 31.344 P < 0.01 and the efficiency of nCPAP therapy was significantly higher than that of OA therapy 86% (37/43), 23% (6/26), χ2=27.36 P < 0.01. CONCLUSION The nCPAP has the best therapeutic efficacy in the treatment of moderate OSAHS followed by OA therapy and the LAUP has worst long-term effect relatively.更多还原