| Objective:Obstructive sleep apnea hypopnea syndrome(OSAHS)is a systemic disease,which is caused by the abnormal anatomy of airway,the change of aerodynamics and the disorder of neuromuscular function.Pathological manifestations such as low blood oxygen status,carbon dioxide retention,respiratory and sleep disorders,chronic inflammation and increased chest pressure will cause multiple system function damage to OSAHS patients.Airway is an important anatomical and functional unit of the respiratory system.The occurrence of airway obstruction will cause serious damage to the respiratory function of the body.Studies have shown that inappropriate treatment of OSAHS is an independent risk factor for the occurrence and development of pulmonary dysfunction.Because of the high incidence rate of OSAHS and the widespread influence of organs,not only the decline of pulmonary function,but also the hypertension,sudden cardiac death,cerebrovascular diseases,cancer,diabetes and other diseases.Therefore,the reasonable and sufficient treatment of this disease is very important.At present,multi-disciplinary treatment mode can improve the state of OSAHS and prevent the damage of cardiopulmonary organs.There is a global consensus on the efficacy of OSAHS multi-level surgical intervention.H-uvulopalatopharyngoplasty(H-UPPP)modified by Han Demin combined with nasal dilatation is used to treat OSAHS patients with nasal and pharyngeal obstruction in our country.The operation can correct the deformity by removing the redundant tissue.It can keep the basic function and increase the ventilation space at the same time.The aim of this study was to analyze the effect of nasal dilatation combined with H-UPPP on sleep disorders in OSAHS patients with nasal and pharyngeal stenosis.This study also research the effect of combined surgery on pulmonary function in patients with OSAHS.Methods: The observation group(n=84)was the moderate and severe OSAHS patients who underwent H-UPPP combined with nasal dilatation in the otorhinolaryngology department of Qingdao Municipal Hospital from January 2017 to April 2019.All the patients in the observation group were received portable polysomnography(PSG),NR6 nasal resistance manometer,high-resolution spiral CT to determine the occlusive plane simultaneously located in the nasal and pharyngeal cavity.The control group included 55 healthy people.The general data of age,rate of smoking,neck circumference,gender,body mass index(BMI)and Epworth sleepiness scale(ESS)of these two group were recorded.And these two groups received pulmonary function test.The observation group received H-UPPP combined with nasal dilatation.And they also received PSG and pulmonary function analysis in the postoperative1-month,postoperative 3-month and postoperative 6-month.The indexes of PSG include apnea hypopnea index(AHI),lowest O2 saturation(LSa O2)at night.Pulmonary function indicators include peak expiratory flow(PEF),75%maximum expiratory flow(MEF75),one second forced expiratory volume(FEV1).Results: There were no differences in age,gender composition and the rate of smoking between the observation group(n=84)and the control group(n=55)(p > 0.05).There were differences in neck circumference,BMI,ESS between the two groups(p <0.001).In the observation group,AHI,LSa O2 and total nasal resistance(TNR)in postoperative were significantly improved than those in preoperative(p < 0.001).The indexes of MEF75,PEF,FEV1 in control group were higher than those in observation group(p < 0.001).In the observation group,MEF75 in postoperative were higher than those in preoperative(p<0.001).There were no differernces in MEF75 among the postoperative1-month,3-month and 6-month(c2=1.058,p=0.589).In the observation group,FEV1 in postoperative were higher than those in preoperative(p<0.001).FEV1 in postoperative3-month and 6-month were higher than those in postoperative1-month(p1=0.007,p2=0.003).There were no differernces in FEV1 between the postoperative 3-month and 6-month(p=0.81).In the observation group,PEF in postoperative 3-month and 6-month were higher than those in preoperative(p<0.001).There were no differernces in PEF between the postoperative1-month and preoperative(p=0.074).PEF in postoperative 3-month and 6-month were higher than those in postoperative 1-month(p<0.001).There were no differernces in PEF between the postoperative 3-month and 6-month(p=0.525).In the observation group,AHI in preoperative was negatively correlated with FEV1 and PEF(r1=-0.436,r2=-0.374,p<0.001).LSa O2 in preoperative was positively correlated with FEV1 and PEF(r1=0.463,r2=0.375,p<0.001).MEF75 in preoperative had no significant correlation with AHI and LSa O2(p1 = 0.129,p2 = 0.055).The effective rate of operation in postoperative 1-month(29.76%)was lower than that in postoperative 3-month(78.57%)and postoperative 6-month(85.71%)(p<0.001).The effective rate of operation in postoperative 3-month and 6-month had no difference(c2=1.461,P=0.227).There were 2 cases of tonsillar hemorrhage and 3 cases of postoperative nasal adhesion occurred after operation.They were all treated for the symptoms.Conclusion:OSAHS can lead to sleep and pulmonary ventilation dysfunction.The degree of pulmonary function damage is related to AHI and LSa O2.H-UPPP combined with nasal dilatation can improve upper respiratory tract ventilation.It can also alleviate the related clinical function damage and improve the pulmonary function. |
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