重度阻塞性睡眠呼吸暂停低通气综合征患者术后红细胞的变化

Changes of red blood cell after ZPPP plus GAHMin patients with severe OSAHS

摘要:

目的 探讨重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome, OSAHS）患者Z型腭咽成形术（Z-palatopharyngoplasty, ZPPP）联合颏舌肌前移舌骨悬吊（genioglossus advancement and hyoid suspension, GAHM）术后红细胞的变化。方法 26例腭咽及舌咽平面阻塞的重度OSAHS（AHI>40）患者，同期行ZPPP联合GAHM手术，术后6个月复查血常规，采用Wilcoxon符号秩和检验分析手术前后各相关参数的变化。结果 术后6个月呼吸紊乱指数由术前（65.58±17.56）次/h降至术后（30.08±23.05）次/h（P<0.01），CT90所占睡眠时间的百分比由术前（30.99±28.13）%隆至术后（15.52±25.55）%（P<0.01），平均血氧饱和度由术前（73.85±28.13）%降至术后（82.77±7.33）%（P<0.01）；红细胞由术前（4.85±0.56）×10 12个/L降至术后（4.77±0.53）×1012个/L（P>0.05），血红蛋白由术前（148.54 ±10.51）g/L下降至术后（147.17±11.90）g/L（P>0.05），红细胞比积由术前（42.62±3.01）%下降至术后（42.67±4.16）% （P>0.05）。结论 ZPPP联合GAHM手术对患者的睡眠呼吸通气指数有所改善，而红细胞未见明显变化。 

Abstract:

Objective To explore change of the red blood cell/hemoglobin after Z-palatopharyngoplasty (ZPPP) plus genioglossus advancement and hyoid suspension (GAHM) in patients with severe obstructive sleep apnea hypopnea syndrome (OSAHS). Methods 26 patients with severe OSAHS (AHI>40) with obstruction in both oropharynx and hypopharynx received ZPPP plus GAHM. All the cases were followed up at least 6 months postoperatively. The Wilcoxon Signed Rank test was used for comparing the changes of the parameters. Results Six months after operation, apnea hyponea undex, percentage of CT90 and saturation of blood oxygen were (65.58±17.56) times/min, (30.99±28.13)% and (73.85±28.13)% respectively, while the preoperative data were (30.08±23.05) times/min, (15.52±25.55)%, and (82.77±7.33)%. The differences in the changes of abovementioned parameters well all statistically significant (P<0.01). Red blood cell count, hemoglobin and percentage of hematocrit were (4.77±0.53)×1012/L, (147.17±11.90) g/L, and (42.67±4.16)% respectively, while the preoperative data were (4.85±0.56)×1012/L, (148.54±10.51) g/L, and (42.62±3.01)%. The differences in the changes of abovementioned parameters were all statistically insignificant (P>0.05). Conclusion The sleep apnea ventilation index were improved obvionsly, while red blood cell count, hemoglobin and hematocrit were reduced with no significance after ZPPP plus GAHM in the patients with severe OSAHS. 