摘要
目的结合上气道解剖结构特征参数,观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠初期须舌肌肌电值指标对腭咽部手术疗效的影响。方法回顾性研究2014年4月至2015年2月在首都医科大学附属北京同仁医院耳鼻咽喉头颈外科35例行腭咽部手术(包括改良腭咽成形术或改良腭咽成形术结合硬腭截短术)治疗的成年OSAHS患者,术前均进行整夜多道睡眠监测(PSG)及同步的须舌肌肌电活性监测,完善上气道CT三维重建扫描。术后3~6个月复查PSG。使用t检验或Wilcoxon检验比较组间变量,釆用Spearman相关性分析检验参数间的相关性。结果35例OSAHS患者中,22例(62.86%)手术治疗有效,13例(37.14%)无效。有效组患者术前的睡眠初期须舌肌平均肌电值较无效组高(15.51±3.74比9.92±2.93,t=4.504,P=0.001)。呼吸暂停低通气指数(AHI)的相对下降值与OSAHS患者术前睡眠初期平均额舌肌肌电值呈正相关(r=0.541,P=0.004),与术前入睡后的平均额舌肌肌电变化值呈正相关(r=0.422,P=0.028)。术后AHI的改变量与腭咽部平均最小横截面积(p=0.629,P=0.000)及平均最小左右径3=0.484,P=0.009)存在明显负相关。结论OSAHS患者入睡初期须舌肌平均肌电值对腭咽部手术疗效有影响。推测腭咽部狭窄,且入睡后须舌肌肌电活性较高的患者可能适合接受手术治疗。
Objective To investigate the effect of genioglossus (GG) activation at sleep onset on the outcome of velopharyngeal surgery in obstructive sleep apnea hypopnea syndrome (OSAHS) patients. Methods Thirty-five patients between April 2014 and February 2015 in Beijing Tongren Hospital with OSAHS underwent overnight polysomnography with synchronous genioglossus electromyography (GGEMG) using intraoral electrodes. The upper airway (UA) anatomy was evaluated by three-dimensional computer tomography (3D-CT) in OSAHS patients. Then, all of the patients received velopharyngeal surgery, including revised uvulopalatopharyngoplasty (UPPP) with uvula preservation or UPPPcombined transpalatal advancement pharyngoplasty. All patients were followed-up using polysomnography 3-6 months after surgery. T-test or Wilcoxon test were used to compare the variables between groups, and Spearman correlation analysis was used to test the conelation between parameters. Results Thirty-five patients received velopharyngeal surgery. Twenty-two patients (62.86%) were responders, and 13 patients (37.14%) were non-responders. Responders had a higher mean GGEMG during sleep onset (15.31±3.74 vs. 9.92±2.93, t=4.504, P=0.001). The decreased AHI was significantly positively related to the sleep onset mean GGEMG (r=0.541, P=0.004) and the change in GGEMG (r=0.422, P=0.028). The decreased AHI was significantly negatively related to the minimal cross sectional airway area (mCSA.ρ=0.629,P=0.000) and the minimal lateral airway dimension (mLAT,ρ=0.484, P=0.009) at velopharynx. Conclusions The outcome of velopharyngeal surgery was affected by the mean GGEMG during sleep onset. We speculated that the patient with higher GGEMG at sleep onset and naiTower velopharynx were more suitable candidates for velopharyngeal surgery.
作者
赵迪
李彦如
曲玥
鲜军舫
曹鑫
张俊波
叶京英
Zhao Di;Li Yanru;Qu Yue;Xian Junfang;Cao Xin;Zhang Junbo;Ye Jingying(Department of Otorhinolaryngology,the Second Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,China;Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tsinghua Chang Gung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Otorhinolaryngology Head and Neck Surgery,Peking University First Hospital,Beijng 100034,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2019年第6期421-426,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
国家自然科学基金(81670918)
国家自然科学基金青年项目(81800894).
关键词
睡眠呼吸暂停
阻塞性
耳鼻喉外科手术
额舌肌
腭咽部手术
口内电极
Sleep apnea,obstructive
Otorhinolaryngologic surgical procedures
Genioglossus
Velopharyngeal surgery
Intraoral electrodes
