山东大学耳鼻喉眼学报 ›› 2014, Vol. 28 ›› Issue (4): 16-19.doi: 10.6040/j.issn.1673-3770.0.2013.327

• 睡眠呼吸障碍性疾病 • 上一篇    下一篇

鼻腔扩容联合改良悬雍垂腭咽成形术对OSAHS患者血压的影响

李景慧1, 吴红敏2   

  1. 1. 中国石油锦西石化医院耳鼻咽喉科, 辽宁 葫芦岛 125001;
    2. 上海交通大学附属第六人民医院耳鼻咽喉科, 上海 200233
  • 收稿日期:2013-11-19 出版日期:2014-08-16 发布日期:2014-08-16
  • 通讯作者: 吴红敏。E-mail：wuhongmin88@126.com E-mail:wuhongmin88@126.com
  • 作者简介:李景慧。E-mail：1240075037@qq.com

Influence of nasal expansion surgery in combination with H-UPPP on blood pressure for OSAHS patients

LI Jing-hui1, WU Hong-min2   

  1. 1. Department of Otolaryngology, JinXi Sinopec Hospital, Huludao, 125001, Liaoning, China;
    2. Department of Otolaryngology, Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University, Shanghai 200233, China
  • Received:2013-11-19 Online:2014-08-16 Published:2014-08-16

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摘要： 目的 观察合并高血压的阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者经鼻腔扩容术、改良腭咽成形（H-UPPP）及两种术式联合治疗前后的血压变化。方法 经多导睡眠监测（PSG）及临床检查确诊的OSAHS合并高血压患者158例，所有患者经上气道CT及纤维喉镜检查明确同时存在鼻腔及咽腔狭窄，分别行鼻腔扩容术（A组53例）、改良腭咽成形（H-UPPP）术（B组52例）及联合手术（C组53例）治疗，术后随访1年，比较三种手术的疗效及其对患者血压影响。结果 术后1年成功随访124例患者，Α组41例，呼吸暂停低通气指数（AHI）从术前（50.6±14.9）降至术后（48.4±13.9），有效5例，有效率12.2%；手术前后血压差异无统计学意义。Β组43例，AHI从术前（53.9±19.0）降至术后（18.1±16.5），有效27例，有效率62.8%；手术前后血压差异有统计学意义。C组40例，AHI从术前（56.0±20.2）降至术后（17.8±15.4），有效31例，有效率77.5%，手术前后血压差异有统计学意义。结论 H-UPPP术及鼻腔扩容联合H-HPPP术对OSAHS有明确的治疗效果，并可以有效改善患者的血压。

关键词: 睡眠呼吸暂停, 阻塞性, 鼻腔扩容术, 腭咽成形术, 高血压

Abstract: Objective To observe the changes of blood pressure in the patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and hypertension after nasal expansion surgery, modified uvulopalatopharyngoplasty or both. Methods 158 OSAHS patients with hypertension diagnosed by polysomnography were enrolled. With upper airway CT scan and fiber laryngoscopy, the obstructive levels were determined in nasal cavity and pharynx. 53 cases (group A) underwent nasal cavity expansion surgery, while 52 cases (group B) underwent modified uvulopalatopharyngoplasty. Another 53 cases (group C) underwent the both procedures. The followed up was set for 1 year. Curative effectiveness and the change of blood pressure were compared among the three groups. Results 124 patients were successfully followed up. The total effective rate was 12.2%, 62.8% and 77.5% in group A, B, C, respectively. Significant changes of blood pressure were noted in the latter two groups. Conclusion H-UPPP alone or combined with nasal expansion surgery demonstrate good therapeutic results in the treatment of OSAHS, and can effectively decrease the patient's blood pressure.

Key words: Sleep apnea, obstructive, Uvulopalatopharyngoplasty, Hypertension, Nasal expansion surgery

中图分类号: 

  • R766.7
[1] 韩德民.关注上呼吸道阻塞性疾病的源头性作用[J].中华耳鼻咽喉头颈外科杂志, 2008, 43(3):161-162.
[2] Levinson P D, McGravey S T, Carlisel C C, et al. Adiposity and cardiovascular risk factors in men with obstructive sleep apnea[J]. Chest, 1993, 103(5):1336-1342.
[3] Hla K M, Young T B, Well T B, et al. Sleep apnea and hypertension: a population-based study[J]. Ann Intern Med, 1994, 120(5):382-388.
[4] Robinson G, Stradling J, Davies R. Sleep 6: obstructive sleep apnea/hypopnea syndrome and hypertension[J].Thorax, 2004, 59(12):1089-1094.
[5] 罗新安, 孙正良. 阻塞性睡眠呼吸暂停低通气综合征的动态血压特征[J]. 山东大学耳鼻喉眼学报, 2006, 20(4):343-348.
[6] Lavie P, Herer P, Hoffstein V. Obstructive sleep apnea syndrome as a risk factor for hypertension: population study[J]. Br Med J, 2000, 320(7):479-482.
[7] Norman M Kaplan. Resistant hypertension[J]. J Hypertens, 2005, 23(8):1441-1444.
[8] Logan A G, Perlikowski S M, Mente A. High prevalence of unrecognized sleep apnea in drug resistant hypertension[J]. J Hypertens, 2001, 19(12):1-7.
[9] Lavie P, Hofftein V. Sleep apnea syndrome: a possible contributing factor to resistant hypertension[J]. Sleep, 2001, 24(6):721-725.
[10] O'Connor G T, Caffo B, Newman A B, et al. Prospective study of sleep-disordered breathing and hypertension: the sleep heart health study[J]. Am J Respir Crit Care Med, 2009, 179(12):1159-1164.
[11] Drager L F, Bortolotto L A, Figueiredo A C, et al. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea[J]. Am J Respir Crit Care Med, 2007, 176(7):706-712.
[12] Dimsdale J E, Loredo J S, Profant J. Effect of continuous positive airway pressure on blood pressure: a placebo trial[J]. Hypertension, 2000, 35(1):144-147.
[13] Becker C, Jerrentrup A, Ploch T, et al. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea[J]. Circulation, 2003, 107(1):68-73.
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