- 期刊
懸雍垂腭咽整形術治療睡眠呼吸中止症候群之長期追蹤
Long-term Follow-up after Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Syndrome
摘要
我們利用懸雍垂腭咽整形手術來治療阻塞型睡眠呼吸中止症群已有多年的經驗。由於此種手術的效果各家報告不一，對於手術效果恒定性以及疾病本身的長期變化也尚不甚了解，此外，關於此種手術後之長期評估的文獻報告也比較少，因此我們認為有做此評估研究的必要。本研究針對20名手術迄今已超過5年，且手術前後均曾接受多項睡眠生理檢查的患者，重新評估其主觀之症狀，並安排接受長期之術後多項睡眠生理檢查。多項睡眠生理檢查包括睡眠呼吸障礙指數、睡眠中血氧濃度低於85%的時間及睡眠中最低之血氧濃度。在接受長期之術後多項睡眠生理檢查的15名患者之中有10名初期之術後睡眠呼吸障礙指數下降超過50%，我們將之歸為手術效果良好者。在這些效果良好的患者中，其長期之術後多睡眠生理檢查結果均仍比手術之前進步。若比較初期及長期之術後多項睡眠生理檢查結果則發現，在睡眠中血氧濃度低於85%的時間及睡眠中最低的血氧濃度均沒有變化。不過，長期之術後睡眠呼吸障礙指數則比初期之術後結果退步，但仍比術前進步。在主觀症狀的長期評估上，80%以上的者自認有進步。因此，主觀的感覺和客觀的結果並不全然有一致性。我們認為對此種治療效果之長期評估應有其必要性。
並列摘要
Uvulopalatopharyngoplasty (UPPP) has been used for the treatment of obstructive sleep apnea syndrome (OSAS) at our hospital since 1984. The reasons of this study consist of the diverse surgical effect, inadequate understanding of operation effect consistency, the possibility of disease progression, and only a few articles reported for long-term evaluation after UPPP. Twenty OSAS patients who had received UPPP for at least five years were included. Polysomnographic parameters inluded respiratory disturbance index, duration of Sa02 ＜ 85% and the lowest 02 saturation. The preoperative, initial postoperative and long-term postoperative polysomnographies were undertaken. The patients with initial postoperative respiratiory disturbance index reduction more than 50% were considered to be responders. In these responders, the long-term follow-up results of polysomnography showed improvement compared with the preoperative data. In comparison with the initial postoperative polysomnographic results, long-term postoperative respiratory disturbance index became worse, while the other two parameters showed no difference. No matter whether the patients were responders or not, more than 80% of them had subjective improvement. In this study , the subjective improvement did not accord with the objective result. We suggest that long-term follow-up after UPPP for OSAS is necessary.