【作者】 王宇；

【导师】 韩东一；

【作者基本信息】 中国人民解放军军医进修学院 ， 耳鼻咽喉科学， 2010， 博士

【摘要】 [目的]探讨一期多平面手术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的手术疗效。[方法]对190例OSAHS患者(2个平面以上狭窄)进行鼻腔手术、舌体消融、悬雍垂腭咽成形术、硬腭截短、Repose骨螺钉舌根和(或)舌骨悬吊手术方式中的二项或二项以上的联合手术,后进行6个月随访,比较资料完整的81例患者手术前后多导睡眠监测及X线测量下气道的参数,评价疗效。[结果]81例患者手术前后平均最低血氧饱和度由(0.71±0.01)提高至(0.82±0.07),差异均有统计学意义(t值分别为18.32、11.04,P值均<0.01)。下咽气道间隙由(12.1±3.2)mm增加至(16.9±2.6)mm,后气道间隙由(9.2±3.3)mm增加至(15.6±2.4)mm,差异均有统计学意义(t值分别为2.5、7.6,P值分别小于0.014和0.000)。治愈28例(AHI<5次／h),占39.5%,有效19例(AHI>20次／h但降低幅度≥50%),占23.5%,无效2例(AHI降低幅度<50%),占2.4%；治愈和显效率达74.1%。[结论]一期多平面手术是治疗OSAHS患者的有效手术方法。[目的]研究重度OSAHS患者采用一期多平面手术治疗前后血清中血管紧张素II (angiotensin II, AngⅡ)、新喋呤(neopterin, Npt)、抵抗素(resistin)、S100β浓度的变化,评估手术治疗对这些因子的影响,探讨OSAHS与AngⅡ、Npt、抵抗素、S100β之间的关系。[方法] 2006年5月-2009年07月于我院住院的重度OSAHS患者30例一期多平面手术治疗前及术后六个月的外周血样本,并采集30例正常健康者外周血样本,采用ELISA方法检测血清AngⅡ、Npt、抵抗素、S100β蛋白水平。[结果]1. AngⅡ与最低SaO2、收缩压、AHI的变化有一定线性关系。随着AHI次数的增加,患者血清Npt浓度也增加。抵抗素与BMI的变化有一定线性关系,随着BMI的增加,抵抗素浓度增加。2. OSAHS患者术前AngⅡ、Npt、抵抗素、s100β蛋白浓度均高于健康对照组(P<0.05).3. OSAHS患者手术治疗后血清AngⅡ、Npt、抵抗素、S100β蛋白浓度均有不同程度下降(P<0.05)。[结论]1.一期多平面手术后患者血压下降与AngⅡ浓度降低,从而ET-1释放减少有关,AngⅡ可能在OSAHS的血压变化中起一定作用。2.NPT是一个与OSAHS病情严重程度相关的因子,可以用来评估OSAS病情,评价手术效果。3. OSAHS患者手术后6个月,血清中抵抗素浓度显著降低,可能与术后患者体重减低有关。4. OSAHS患者术前S100β蛋白浓度显著高于对照组,采用手术治疗6个月后,S100β蛋白浓度显著降低。可能与患者术后日间嗜睡症状缓解,记忆力明显升高有关。更多还原

【Abstract】 Objective To treat obstructive sleep apnea-hypopnea syndrome (OSAHS) with one stage multilevel operation and evaluate treating effect. Methods One hundred and ninety patients of OSAHS (who have at least 2 obstruction levels) were treat with tongue coblation+uvulopalatopharyngoplasty+hard palate shortening+Repose suspension. The length of follow up was 6 months and complete data of 81 patients was collected. Apnea hypopnea index (AHI), lowest oxygen percent saturation (LSaO2), body mass index (BMI), vallecula epiglottica-lateral pharyngeal wall (V-LPW) and pharyngeal airway space (PAS) was used for diagnosis and evaluation. Results The LSaO2 of 81 patients increased from (0.71±0.01) to (0.82±0.07) (x±s),t=18.32.11.04, P＜0.01.The AHI reduced from (0.632±0.007) to (0.794±0.006),t=4.1, P=0.000. The V-LPW increased from (12.1±3.2) mm to (16.9±2.6) mm (t=2.5, P=0.014). PAS increased from (9.2±3.3) mm to (15.6±2.4) mm (t=7.6, P=0.000). The total effective rate is 74.1%. Conclusion one stage multilevel operation is an effective method of safety, simplicity. Objective To treat obstructive sleep apnea-hypopnea syndrome(OSAHS) with one stage multilevel operation and evaluate the consistency change in angiotensin II, AngⅡ, neopterin, resistin, S100β. Methods Thirty patients of OSAHS were treat with tongue coblation+uvulopalatopharyngoplasty+hard palate shortening+Repose suspension. The serum of the the patients and normal people were taken before opration and 6 months later. ELISA was taken to evaluate the consistency change in angiotensin II, AngⅡ, neopterin, resistin, S100β. Results 1. AngⅡwas related with the LSaO2, systolic pressure, AHI.The Npt increased with AHI. Resistin increased with the BMI.2.The level of angiotensinⅡ, AngⅡ, neopterin, resistin, S100βin OSAHS patients were higher than control group (P＜0.05).3. The level of angiotensin II, AngⅡ, neopterin, resistin, S100βdecreased after opration (P<0.05).Conclusion 1. The systolic pressure decreased with Ang II level after one stage multilevel operation. AngⅡmight related with the change of the BP.2. NPT was related with the svere of OSAHS and might be used to evaluate the svere of OSAHS and the therapeutic effectiveness of the operation.更多还原