阻塞性睡眠呼吸暂停低通气综合征患者软腭平面手术疗效的Meta分析

doi:10.6040/j.issn.1673-3770.0.2017.047

摘要/Abstract

摘要： 目的系统评价软腭平面手术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法检索MEDLINE、PubMed和Cochrane图书馆临床对照试验资料库中有关OSAHS软腭平面手术的临床研究,时限均从建库至2015年10月,并对所获文献的参考文献进行回溯性检索和引文检索。由两位研究者严格按纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.1.0软件进行Meta分析。结果初检出2 767篇文献,通过阅读文题、摘要和全文逐层筛选,最终纳入20个研究,共631例患者,其中约88%为男性患者。质量评价由两位研究者独立进行并交叉核对,如遇分歧讨论决定。质量评价标准根据Cochrane系统评价员手册5.1.0 进行,纳入研究的方法学质量显示部分研究存在高度偏倚的可能性。本组纳入研究的研究对象均以多导睡眠检查作为诊断标准,但对阻塞部位的评估多数采用客观检查主观评估的方法,较少采用客观评估的研究。Meta分析结果显示OSAHS患者行单纯软腭平面手术治疗后呼吸暂停低通气指数、动脉最低血氧饱和度、Epworth量表评分均较术前明显改善。敏感性分析显示本研究结果较稳定。结论 (1) 尚且缺乏较高质量的临床研究,对于阻塞部位评估大多缺乏客观指标;(2) 软腭平面手术可以显著降低OSAHS患者的呼吸暂停指数及Epworth量表评分并提高最低动脉血氧饱和度;(3) 尚且没有依据提示某种术式比其他术式更有效。

关键词: 打鼾, 软腭, 悬雍垂腭咽成形术, 改良悬雍垂腭咽成形术, 睡眠呼吸暂停,阻塞性

Abstract: Objective To assess the efficacy of various soft palate surgeries for obstructive sleep apnea hypopnea syndrome(OSAHS). Methods Clinical studies of the soft palate surgical procedures for OSAHS were searched in databases including Cochrane, MEDLINE and PubMed, from their inception to October, 2015. References of the selected studies then underwent retrospective review and citation retrieval. Two reviewers independently screened the articles according to the predefined inclusive and exclusive criteria, and then extracted necessary data and evaluated quality of the included studies. A meta-analysis was performed using RevMan 5.1.0. Results A total of 20 self-controlled trials or RCTs involving 631 patients(88% males)were finally included. Quality evaluation was conducted independently by the two reviewers and crosschecked. Polysomnograph was adopted as a diagnostic criterion, but subjective assessment was used often for the evaluations of obstructive sites. Meta-analyses showed a significant improvement in apnea hyponea index(AHI), lowest saturation(LSAT)and Epworth sleepiness scale score(ESS). Sensitivity analysis indicated that these results were stable. Conclusion High-quality studies as well as objective indicators for the evaluation of obstructive sties are still needed. The soft palate surgeries are effective in reducing AHI and ESS, and enhancing LSAT. To date, no evidence has suggested one surgical approach is more effective than the others.

Key words: Modified uvulopalatopharyngoplasty, Soft palate, Meta-analysis, Sleep apnea, obstructive, Uvulopalatopharyngoplasty, Snoring

中图分类号:

R766.7

李静,史雅文,李佳宸,殷敏,程雷. 阻塞性睡眠呼吸暂停低通气综合征患者软腭平面手术疗效的Meta分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 55-63.

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