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鼻腔扩容术对阻塞性睡眠呼吸暂停低通气
综合征患
者鼾声的影响
杨弋黄魏宁许辉杰
彭好
【摘要】
目的研究对伴有鼻堵的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者实施鼻腔
扩容术后的治疗效果以及对鼾声声学特征的影响。方法2011年4月—2012年10月卫生部北京医
院耳鼻咽喉科22例行鼻腔扩容术的伴鼻阻塞的OSAHS患者的病历资料。患者手术前后分别进行整
夜睡眠的鼾声、多导睡眠监测及鼻阻力检测。记录患者体质指数(BMI)、Epworth嗜睡量表(ESS)评
分、呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(SaO:)、总鼻阻力以及鼾声声音信号的最大频
率(fmax)、中心频率(fc)、平均频率(fmean)、峰值频率(fpeak)、800
Hz功率比(PR800)等各项声学参
数。应用配对t检验比较手术前后BMI、ESS、AHI、最低SaO:、总鼻阻力的变化,Wilcoxon非参数检验
比较各项声学参数的变化。结果
OSAHS患者手术后最低SaO:较术前升高,差异有统计学意义
(P<0.05)。手术前后总鼻阻力分别为(0.39±0.15)和(0.29±0.11)Pa·cm一·s~,差异有统计学
意义(P<0.01)。鼻腔扩容术前后OSAHS暂停后鼾声时域图、能量谱图均有明显变化。手术后,
fpeak较术前降低,PR800较术前升高,差异均有统计学意义(均P<0.01)。结论鼻腔扩容手术降
低了OSAHS患者的鼻阻力,改变了OSAHS患者的鼾声声学特征,鼾声有可能成为OSAHS手术疗效
的评价指标之一。
【关键词】打鼾;声学;睡眠呼吸暂停综合征,阻塞性;耳鼻喉外科手术
Effects
of
nasal
cavity
enlarging
surgery
on
snoring
in
obstructive
sleep
apnea
hypopnea
syndrome
patients
YANG
Yi.HUANG
Wei—ning,XU
Hui-fie.PENG
Hao.Department
of
Otolaryngology,Be电讯g
Hospitaf,Ministry
of
Health,Be加ng
100730,Chiua
Corresponding
author:HUANG
Wei—ning,Email:weininghuang@sinca
con
【Abstract】0bjective
To
explore
the
efficacies
of
nasal
cavity
enlarging
surgery
in
obstructive
sleep
apnea
hypopnea
syndrome(OSAHS)patients
with
nasal
obstruction.Methods
From
April
201
1
to
October
2012.a
total
of
22
OSAHS
patient
with
nasal
obstruction
underwent
nasal
cavity
efIlargement.Natural
overnight
snoring
was
digitally
recorded,polysomnography(PSG)performed
simuhaneously
and
nasal
resistance
measured
at
pre—and
post-operation.Body
mass
index(BMI),Epwoah
sleepiness
scale(ESS),
apnea—hypopnea
index(AHI),minimum
oxygen
saturation
Sa02,total
nasal
resistance,peak
frequency,
maximal
frequency,mean
frequency,central
frequency
and
power
ratio
800
Hz
of
snores
were
recorded
and
compared.Results
BMI
and
SaO,rose
while
AHI
and
ESS
declined
post—operatively.No
statistical
difference
existed
between
pre—operation
and
post—operation.The
total
nasal
resistance
Was(0.39±0.15)
and
f
0.29±0.11)Pa·cm~·s~at
pre.and
post—operation.And
there
was
significant
statistical
difference(P<0.01).The
snores
at
pre—and
post.operation
exhibited
different
patterns
in
time
and
power
spectrum
distribution
domains.And
fmax,fpeak
and
fmcan
declined
while
fc
and
PR800
rose
at
post—
operation.Significant
statistical
differences
existed
in
the
change
of
fpeak
and
PR800
at
pre—and
post—
operation(P<0.01).Conclusion
Nasal
cavity
enlargement
can
lessen
nasal resistance
and
change
the
acoustic
characteristics
of
snoring
in
OSAHS
patients.The
postoperative
snoring
focus
of
lower
frequency
suggests
that
acoustic
parameters
of
snores
may
be
used to
evaluate
the
efficacy
of
OSAHS
surgery.
【Key
words】
Snoring;
Acoustic;
Sleep
apnea,obstructive; Otorhinolaryngologic
surgical
procedures
DOI:10.3760/cma.j.issn.0376-2491.2013.38.009
基金项目:国家自然科学基金(61271410)
作者单位:100730卫生部北京医院耳鼻咽喉科
通信作者:黄魏宁,Email:weininghuang@sina.tom
.临床研究.
万方数据