H-UPPP联合低温等离子舌根射频消融术对OSAHS患者血氧饱和度及动脉血氧分压的影响

doi:10.6040/j.issn.1673-3770.0.2023.488

摘要/Abstract

摘要： 目的探讨改良悬雍垂腭咽成形术(han-uvulopalatopharyngoplasty, H-UPPP)联合低温等离子舌根射频消融术对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)患者血氧饱和度及动脉血氧分压(arterial partial pressure of oxygen, PaO₂)的影响。方法选取OSAHS患者72例,根据手术方式将其分为H-UPPP手术组(采用单一H-UPPP治疗)和联合手术组(采用H-UPPP联合低温等离子舌根射频消融术治疗),有2例失访,最终70例纳入本研究,其中H-UPPP手术组35例,联合手术组35例;比较两组术前和术后6个月低通气指数(apnea hypopnea index, AHI)、最低血氧饱和度(lowest oxygen saturation, LSaO₂)、PaO₂、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide, PaCO₂)、用力肺活量、第1秒用力呼气容量、Epworth嗜睡量表(epworth sleepiness scale, ESS)评分及模拟视觉量表(visual analogue scale, VAS)评分,观察两组临床疗效及术后不良反应。结果术后6个月,联合手术组和H-UPPP手术组AHI和PaCO₂较术前均降低,LSaO₂、PaO₂均增加(P均<0.05),联合手术组AHI低于H-UPPP手术组,LSaO₂、PaO₂高于H-UPPP手术组(P=0.036、0.030、0.001),但组间PaCO₂比较差异无统计学意义(P=0.737);联合手术组和H-UPPP手术组用力肺活量、第1秒用力呼气容量较术前均增加(P均<0.05),联合手术组用力肺活量、第1秒用力呼气容量均大于H-UPPP手术组(P均<0.001);两组ESS评分均降低,VAS评分均升高,联合手术组ESS评分低于H-UPPP手术组,VAS评分高于H-UPPP手术组。联合手术组治疗总有效率高于H-UPPP手术组(P=0.025);两组术后并发症总发生率比较,差异均无统计学意义(P=0.353)。结论 H-UPPP联合低温等离子舌根射频消融术可有效促进OSAHS患者肺功能恢复,改善LSaO₂、PaCO₂及PaO₂,临床疗效较好,安全性较佳。

关键词: 腭咽成形术, 射频消融术, 舌, 阻塞性睡眠呼吸暂停低通气综合征, 肺功能, 血氧饱和度, 动脉血氧分压

Abstract: Objective To explore the effect of han-uvulopalatopharyngoplasty(H-UPPP)combined with radiofrequency ablation of tongue root at low temperature on oxygen saturation and arterial partial pressure of oxygen(PaO₂)in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods Seventy-two patients with OSAHS were selected. They were divided into H-UPPP operation group(treated with single H-UPPP)and combined operation group(treated with H-UPPP combined with low-temperature plasma radiofrequency ablation of tongue root)according to the operation methods. Two patients were lost to follow-up, and finally 70 patients were included in this study. There were 35 patients in H-UPPP operation group and 35 patients in combined operation group. The apnea hypopnea index(AHI), low est oxygen saturation(LSaO₂), PaO₂, arterial partial pressure of carbon dioxide(PaCO₂), forced vital capacity, forced expiratory volume in the first second, Epworth sleepiness scale(ESS)and visual analogue scale(VAS)were compared between the two groups before and 6 months after operation. The clinical efficacy and postoperative adverse reactions of the two groups were observed. Results Six months after operation, AHI and PaCO₂ in the combined operation group and H-UPPP operation group decreased compared with that before operation, while LSaO₂ and PaO₂ increased(all P<0.05). The AHI of combined operation group was lower than that of H-UPPP operation group, and LSaO₂, PaO₂ were higher than that of H-UPPP operation group(P=0.036, 0.030, 0.001). But there was no significant difference in PaCO₂ between the two groups at six months after operation(P=0.737). The forced vital capacity and forced expiratory volume in the first second in the combined operation group and H-UPPP operation group were higher than those before operation(all P<0.05). The forced vital capacity and forced expiratory volume in the combined operation group were higher than those in the H-UPPP operation group(all P<0.001).The ESS score decreased and the VAS score increased in both groups. The ESS score of combined operation group was lower than that of H-UPPP operation group, and the VAS score was higher than that of H-UPPP operation group. The total effective rate of the combined operation group was higher than that of the H-UPPP operation group(P=0.025). There was no significant difference in the total incidence of postoperative complications between the two groups(P=0.353). Conclusion H-UPPP combined with radiofrequency ablation of tongue root with low temperature plasma can effectively promote the recovery of lung function and improve LSaO₂, PaCO₂, and PaO₂ in patients with OSAHS, with good clinical efficacy and safety.

Key words: Uvulopalatopharyngoplasty, Ablation techniques, Tongue, Obstructive sleep apnea hypopnea syndrome, Lung function, Oxygen saturation, Arterial partial pressure of oxygen

中图分类号:

R563.8

王桂芳,李仁高,马青. H-UPPP联合低温等离子舌根射频消融术对OSAHS患者血氧饱和度及动脉血氧分压的影响[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 49-54.

WANG Guifang, LI Rengao, MA Qing. Effects of H-UPPP combined with radiofrequency ablation of tongue root with low temperature plasma on oxygen saturation and arterial oxygen partial pressure in patients with OSAHS[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(3): 49-54.

参考文献

[1] 邢亮, 袁钰淇, 谢雨杉, 等. 不同觉醒阈值阻塞性睡眠呼吸暂停低通气患者对血气、糖脂代谢水平的影响[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 106-111. doi:10.6040/j.issn.1673-3770.0.2023.170 XING Liang, YUAN Yuqi, XIE Yushan, et al. Metabolic markers in obstruetive sleep apnea hypopnea syndrome patients with different arousal thresholds[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 106-111. doi:10.6040/j.issn.1673-3770.0.2023.170
[2] Yuan FL, Wu SX, Tang JH, et al. Efficacy analysis of extended uvulopalatopharyngoplasty combined with the simultaneous multiplane operation to treat obstructive sleep apnea[J]. J Craniofac Surg, 2023, 34(5): e425-e429. doi:10.1097/SCS.0000000000009226
[3] Zhan XJ, Li L, Wu C, et al. Effect of uvulopalatopharyngoplasty(UPPP)on atherosclerosis and cardiac functioning in obstructive sleep apnea patients[J]. Acta Otolaryngol, 2019, 139(9): 793-797. doi:10.1080/00016489.2019.1633475
[4] Tsou YA, Huang CW, Wu TF, et al. The effect of tongue base suspension with uvulopalato-pharyngoplasty on sleep quality in obstructive sleep apnea[J]. Sci Rep, 2018, 8(1): 8788. doi:10.1038/s41598-018-27094-w
[5] 税磊, 余文兴. 低温等离子舌根射频消融术对舌源性OSAHS患者机体免疫功能与动态血压的影响[J]. 医学综述, 2016, 22(6): 1218-1220. doi:10.3969/j.issn.1006-2084.2016.06.052 SHUI Lei, YU Wenxing. Effect of low temperature plasma radiofrequency ablation on the immune function and ambulatory blood pressure in patients with tongue originated OSAHS[J]. Medical Recapitulate, 2016, 22(6): 1218-1220. doi:10.3969/j.issn.1006-2084.2016.06.052
[6] 郁文俊, 朱华明, 许华俊, 等. HUPPP联合舌根射频消融术或舌根牵引术治疗中重度OSAHS的疗效对比研究:一项多中心随机对照试验[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(12): 1248-1255. doi:10.3760/cma.j.cn115330-20210429-00237 YU Wenjun, ZHU Huaming, XU Huajun, et al. Efficacy of Han-uvulopalatopharyngoplasty(HUPPP)combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome(OSAHS): a multicenter randomized controlled trial[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2021, 56(12): 1248-1255. doi:10.3760/cma.j.cn115330-20210429-00237
[7] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会咽喉学组. 阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(2): 95-96. doi:10.3760/cma.j.issn.1673-0860.2009.02.003
[8] MacKay S, Carney AS, Catcheside PG, et al. Effect of multilevel upper airway surgery vs medical management on the apnea-hypopnea index and patient-reported daytime sleepiness among patients with moderate or severe obstructive sleep apnea: the SAMS randomized clinical trial[J]. JAMA, 2020, 324(12): 1168-1179. doi:10.1001/jama.2020.14265
[9] Huang CC, Cheng PW, Liao LJ, et al. Reduction of postural nasal resistance following oropharyngeal surgery in patients with moderate-severe obstructive sleep apnea[J]. Rhinology, 2021, 59(1): 75-80. doi:10.4193/Rhin19.331
[10] 李玉杰, 韩伟, 黄炜, 等. 加速康复外科在44例悬雍垂腭咽成形术中的应用[J]. 山东大学学报(医学版), 2020, 58(11): 92-97. doi:10.6040/ j.issn.1671-7554.0.2020.908 LI Yujie, HAN Wei, HUANG Wei, et al. Application of enhanced recovery after surgery in 44 cases of uvulopalatopharyngoplasty[J]. Journal of Shandong University(Health Sciences), 2020, 58(11): 92-97. doi:10.6040/ j.issn.1671-7554.0.2020.908
[11] Tsou YA, Hsu CC, Shih LC, et al. Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea syndrome: modified uvulopalatopharyngoplasty versus barbed reposition pharyngoplasty[J]. J Clin Med, 2021, 10(14): 3169. doi:10.3390/jcm10143169
[12] 刘剑勇, 李梦琳, 陆建斌, 等. 改良悬雍垂腭咽成形术联合舌根射频消融治疗阻塞性睡眠呼吸暂停低通气综合征的对照研究[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(4): 276-280. doi:10.3760/cma.j.issn.1673-0860.2018.04.007 LIU Jianyong, LI Menglin, LU Jianbin, et al. Control study of H-uvulopalatopharyngoplasty combined with tongue base radiofrequency for the treatment of obstructive sleep apnea hypopnea syndrome[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2018, 53(4): 276-280. doi:10.3760/cma.j.issn.1673-0860.2018.04.007
[13] Calvo-Henriquez C, Boronat-Catala B, Rivero-Fernández I, et al. Safety of tongue base procedures for sleep apnoea in adults: a systematic review and metanalysis from the YO-IFOS study group[J]. Acta Otorrinolaringol Esp, 2022, 73(6): 384-393. doi:10.1016/j.otoeng.2021.10.004
[14] 崔前波, 谭健, 邹哲飞, 等. 阻塞性睡眠呼吸暂停低通气综合征患者改良悬雍垂腭咽成形术术后上气道重塑规律研究[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(7): 497-500. doi:10.13201/j.issn.2096-7993.2022.07.003 CUI Qianbo, TAN Jian, ZOU Zhefei, et al. Morphological changes of upper airway in patients with obstructive sleep apnea hypopnea syndrome after H-UPPP[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2022, 36(7): 497-500. doi:10.13201/j.issn.2096-7993.2022.07.003
[15] 翟性友, 李北成, 陈立伟, 等. 腭帆肌悬吊术在成人重度阻塞性睡眠呼吸暂停低通气综合征中的应用[J]. 广东医学, 2022, 43(5): 626-630. doi:10.13820/j.cnki.gdyx.20212086 ZHAI Xingyou, LI Beicheng, CHEN Liwei, et al. The application of the palatine veil muscle suspension in adults with severe obstructive sleep apnea hypopnea syndrome[J]. Guangdong Medical Journal, 2022, 43(5): 626-630. doi:10.13820/j.cnki.gdyx.20212086
[16] 田秋实, 初腾, 逄明杰, 等. 改良悬雍垂腭咽成形联合鼻腔扩容术对多平面阻塞OSAHS患者肺功能的影响[J]. 山东医药, 2020, 60(5): 57-59. doi:10.3969/j.issn.1002-266X.2020.05.014 TIAN Qiushi, CHU Teng, PANG Mingjie, et al. Effect of modified uvulopalatopharyngoplasty combined with nasal cavity expansion on lung function in patients with multiplanar obstructive OSAHS[J]. Shandong Medical Journal, 2020, 60(5): 57-59. doi:10.3969/j.issn.1002-266X.2020.05.014
[17] 陈彩凤, 张湘民, 朱任良, 等. 移位-线牵拉扩张咽成形术治疗软腭口咽阻塞为主的OSAHS的疗效研究[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(12): 1270-1276. doi:10.3760/cma.j.cn115330-20210707-00436 CHEN Caifeng, ZHANG Xiangmin, ZHU Renliang, et al. Efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of OSAHS with soft palate oropharyngeal obstruction[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2021, 56(12): 1270-1276. doi:10.3760/cma.j.cn115330-20210707-00436
[18] Bahgat A, Bahgat Y, Alzahrani R, et al. Transoral endoscopic coblation tongue base surgery in obstructive sleep apnea: resection versus ablation[J]. ORL J Otorhinolaryngol Relat Spec, 2020, 82(4): 201-208. doi:10.1159/000506994
[19] 李卓君, 宋西成, 陈秀梅. 阻塞性睡眠呼吸暂停低通气综合征患者的肺功能变化分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(2): 45-50. doi:10.6040/j.issn.1673-3770.0.2022.043 LI Zhuojun, SONG Xicheng, CHEN Xiumei. Analysis of pulmonary function changes in patients with obstructive sleep apnea hypopnea syndrome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(2): 45-50. doi:10.6040/j.issn.1673-3770.0.2022.043
[20] Sundman J, Browaldh N, Fehrm J, et al. Eight-year follow-up of modified uvulopalatopharyngoplasty in patients with obstructive sleep apnea[J]. Laryngoscope, 2021, 131(1): E307-E313. doi:10.1002/lary.28960

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