阻塞性睡眠呼吸中止症病人術後症狀困擾的改變

目的：睡眠呼吸中止症是最常見的睡眠問題且影響健康重要疾病，經口達文西機器手臂手術是有效治療阻塞性睡眠呼吸中止症的方法。因此本研究目的是在追蹤阻塞性睡眠呼吸中止症病人，接受經口達文西機器手臂手術後症狀困擾的改變情形。方法：本研究採病歷回溯性研究，於南區某醫學中心阻塞性睡眠呼吸中止症，接受經口達文西機器手臂病人，以縱貫性研究設計，收集時間點分成術前、術後一個月、三個月及六個月共有103名有效樣本，分析資料包括：基本資料、呼吸中止指數、艾普沃斯嗜睡量表、打鼾視覺類比量表及味覺、嗆食及咽喉異物感的改變。結果：(1)男性在呼吸中止指數嚴重程度的比例顯著高於女性(χ² = 14.6, p = .001），沒有吸煙者比例高於有抽煙者(χ² = 7.7, p = .01)。(2)術後6個月的呼吸中止嚴重程度(χ² = 29.0, p < .001)、白天嗜睡程度(χ² = 24.9, p < .001)較術前有顯著改善。(3)術後第1、3及6個月味覺的敏銳度會同時出現1-4種的變化，其中以對鹹味敏感居多，其次為甜味。(4)術前打鼾平均10.0分，術後6個月平均2.0分，皆有改變。討論：依據研究結果可強化護理人員教育課程，內容包括經口達文西機器手臂手術，病人於術後6個月呼吸中止指數、白天嗜睡程度與打鼾程度的情形改善，及症狀困擾味覺改變、異物感及嗆食之情形會隨時間其症狀漸消失；並可做為臨床護理人員照顧接受經口達文西機器手臂病人，手術前指導及出院衛教的指引。

關鍵字

阻塞性睡眠呼吸中止症；呼吸中止指數；艾普沃斯嗜睡量表；打鼾視覺類比量表；症狀困擾

並列摘要

Purpose: Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder and a significant concern for clinical practice. Trans-Oral Robotic Surgery(TORS) has been identified as an effective surgery for treatment of OSAS. This study aimed to examine the changes of symptom distress underwent operation in patients with OSAS. Methods: This retrospective study by means of chart reviews was conducted at a medical center in southern Taiwan. Patients with OSAS who underwent TORS were included in the longitudinal study design. Data were collected at four time points; that were pre-surgery, and 1-, 3-, and 6-month after post-surgery. A total of 103 subjects were analyzed. Data collected included personal profile (demographics, smoke, and disease history), the Apnea-Hypopnea index, the Epworth Sleepiness Scale, the Snoring Visual Analog Scale, and the check lists of changes in taste, choking, and throat sensation. Results: The proportion of males with different levels of severity in the Apnea-Hypopnea Index was significantly higher than that of females (χ² =14.6, p = .001), and the proportion of non-smokers was higher than that of smokers (χ² = 7.7, p = .01) (2) Compared to pre-operation, the severity of apnea (χ² = 29.0, p < .001) and daytime sleepiness (χ² = 24.9, p < .001) showed significant improvement after 6-month post-surgery. (3) Sensitivity to taste changes appeared in 1-4 categories at 1-, 3-, and 6-month after post-surgery. Salty taste is the most sensitivity, followed by sweet taste. And (4) the average snoring score decreased from 10.0 to 2.0 between pre-operation and 6 months after post-surgery. Discussion: The results can provide nurses more insight into knowledge while taking care of patient pre- or underwent TORS. The continued education modules are composed of any syndromes changes after TORS within six months. Based upon the findings, a possible pre- and post-operation principle would instruct nurses to take care patients who intend to receive TORS.