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目的以上气道-食管持续压力测定定位阻塞性睡眠呼吸暂停患者咽腔阻塞部位,评价定位诊断指标预测悬雍垂腭咽成形术疗效的准确性。方法以整夜多道睡眠监测与同步上气道-食管压力持续测定对患者每次咽腔阻塞的部位定位,以腭咽、舌咽、喉咽各平面来源的气遭阻塞、塌陷次数占总次数的构成比定量表示各平面参与气道塌陷的作用大小。对27例选择改良悬雍垂腭咽成形术治疗的患者进行随访,术后6个月复查多道睡眠监测,结果以呼吸暂停低通气指数(apnea andhypopnea index,AHI)较术前下降的比例≥50%为显效标准,手术总显效率51.9%。AHI 下降比例与腭咽构成比和腭咽阻塞指数正相关(r 分别为0.609和0.521),与舌咽构成比负相关(r=-0.479)。术后 AHI 与腭咽构成比、舌咽构成比和阻塞指数相关(r 分别为-0.675、0.542和0.647)。腭咽构成比≥70%者10例,9例手术显效,腭咽构成比<60%者10例,无显效者。以腭咽构成比≥60%作为预测手术显效的标准,预测一致率88.9%(24/27)。综合舌咽阻塞指数,腭咽、舌咽构成比、扁桃体大小及其他多道睡眠监测指标对术后 AHI 进行多元线性回归分析,r~2=0.632(F=6.701,P=0.001)。结论以上气道-食管持续压力测定各阻塞平面参与气道塌陷的作用大小,可较好地预测腭咽平面气道重建手术的疗效。以腭咽构成比为指标,可获得88.9%的预测一致率。
OBJECTIVE: To evaluate the accuracy of positioning diagnostic criteria in predicting the curative effect of uvulopalatopharyngoplasty in the upper airway - esophageal continuous pressure measurement and localization of pharyngeal obstruction in obstructive sleep apnea patients. Methods All night pharyngeal sleep monitoring and synchronous upper airway - esophageal pressure measurement were performed to determine the location of each pharyngeal obstruction in the patients. Obstructions of pharyngeal, glossopharyngeal and pharyngeal pharyngeal air were obstructed and the number of collapse was The ratio of the number of quantitative than that of the plane involved in the role of airway collapse size. Twenty-seven patients who underwent modified uvulopalatopharyngoplasty were followed up for six months after operation. The results showed that the ratio of apnea and hypopnea index (AHI) to preoperative decrease was ≥ 50% for markedly effective, the total effective rate of 51.9%. The proportion of decrease in AHI was positively correlated with the velopharyngeal composition ratio and the velopharyngeal obstruction index (r = 0.609 and 0.521, respectively), and negatively correlated with glossopharyngeal composition (r = -0.479). Postoperative AHI and velopharyngeal composition ratio, glossopharyngeal composition ratio and obstruction index (r were -0.675,0.542 and 0.647, respectively). Velopharyngeal composition ratio ≥ 70% in 10 cases, 9 cases of surgery was effective, velopharyngeal composition ratio <60% in 10 cases, no effective. To velopharyngeal composition ratio ≥ 60% as the standard of predictive operation was effective, the consensus rate was 88.9% (24/27). The multiple linear regression analysis of postoperative AHI with comprehensive glossopharyngeal obstruction index, velopharyngeal, glossopharyngeal composition ratio, tonsil size and other multi-channel sleep monitoring indexes was performed. R = 2 = 0.632 (F = 6.701, P = 0.001). Conclusion The above airway - esophageal continuous pressure measurement of the obstruction of the plane involved in the size of the role of airway collapse, can better predict the efficacy of velopharyngeal plane airway reconstruction surgery. With the ratio of velopharyngeal composition as an index, a predictive agreement rate of 88.9% can be obtained.