藥物誘導(dǎo)睡眠內(nèi)鏡VOTE評(píng)分在OSAHS手術(shù)治療中的價(jià)值
發(fā)布時(shí)間：2018-12-28 20:19
【摘要】：目的和意義阻塞性睡眠呼吸暫停低通氣綜合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)手術(shù)治療前,運(yùn)用藥物誘導(dǎo)睡眠內(nèi)鏡檢查(Drug-induced sleep endoscopy,DISE)評(píng)估上氣道阻塞平面,制定手術(shù)策略,以提高手術(shù)治療療效。但是,DISE檢查缺少描述所觀察到結(jié)果的統(tǒng)一標(biāo)準(zhǔn),影響DISE對(duì)阻塞部位的定位及阻塞程度的評(píng)估,近年來(lái)國(guó)外文獻(xiàn)提出了VOTE(velum,oropharynx,tonguebase,epiglottis)評(píng)分系統(tǒng),用于記錄DISE檢查結(jié)果,但國(guó)內(nèi)還未見(jiàn)類(lèi)似研究。本課題擬通過(guò)運(yùn)用VOTE評(píng)分系統(tǒng),記錄患者在睡眠狀態(tài)時(shí)上氣道阻塞形態(tài),并比較清醒狀態(tài)進(jìn)行內(nèi)鏡下Muller's檢查和Friedman臨床分型評(píng)估方法之間存在的差異。分析DISE檢查VOTE評(píng)分結(jié)果與多平面手術(shù)療效的關(guān)系。研究方法經(jīng)多導(dǎo)睡眠監(jiān)測(cè)診斷為OSAHS的56例患者,每位患者進(jìn)行Friedman臨床分型,并分別進(jìn)行清醒時(shí)Muller's檢查及藥物誘導(dǎo)睡眠內(nèi)鏡檢查,其中40例患者存有錄像記錄檢查結(jié)果。統(tǒng)一使用VOTE評(píng)分系統(tǒng)來(lái)描述內(nèi)鏡檢查過(guò)程中所觀察到上氣道的阻塞平面、阻塞程度及阻塞形態(tài),比較DISE和Muller's檢查兩種檢查結(jié)果的差異,并比較不同阻塞程度的患者間BMI、AHI、最低血氧飽和度及平均血氧飽和度是否存在差異。比較DISE與Friedman臨床分型對(duì)評(píng)估上氣道阻塞程度的差異。對(duì)根據(jù)DISE結(jié)果進(jìn)行了多平面手術(shù)的患者進(jìn)行短期及長(zhǎng)期療效分析。結(jié)果第一章:DISE結(jié)果提示40例存有檢查錄像結(jié)果的OSAHS患者主要的上氣道阻塞部位仍在腭咽平面,以完全性阻塞為主(90%),其中以環(huán)形阻塞(95%)最為常見(jiàn)。口咽側(cè)壁完全阻塞率60%,舌根完全阻塞率17.5%。清醒狀態(tài)的Muller's檢查主要觀察到腭咽平面及口咽側(cè)壁平面的阻塞,完全阻塞率分別為52.5%和30%。根據(jù)VOTE評(píng)分,40例患者DISE檢查在腭咽、口咽側(cè)壁、舌根及會(huì)厭平面上的得分均高于清醒狀態(tài)的Muller's檢查,均有統(tǒng)計(jì)學(xué)差異(P值0.05)。DISE檢查結(jié)果中,腭咽平面,部分阻塞的患者與完全阻塞的患者,AHI值及最低血氧飽和度有統(tǒng)計(jì)學(xué)差異(P值0.05)�？谘蕚�(cè)壁、舌根及會(huì)厭平面,不同阻塞程度的患者間上述指標(biāo)均無(wú)統(tǒng)計(jì)學(xué)差異(P值0.05)。Muller's檢查中,各平面不同阻塞程度患者間BMI、AHI、最低血氧飽和度及平均血氧飽和度均無(wú)統(tǒng)計(jì)學(xué)差異(P值0.05)。第二章:在DISE與Friedman臨床分型的比較中,56例患者口咽平面不同扁桃體分級(jí)組間阻塞率有統(tǒng)計(jì)學(xué)差異(P值0.05)。舌根平面的不同F(xiàn)riedman臨床分型組間的阻塞率無(wú)統(tǒng)計(jì)學(xué)差異(P值0.05),不同F(xiàn)riedman舌背分級(jí)組間阻塞率有統(tǒng)計(jì)學(xué)差異(P值0.05)。第三章:手術(shù)療效分析提示,口咽側(cè)壁平面短期療效無(wú)效組和有效組間的阻塞率有統(tǒng)計(jì)學(xué)差異(P值0.05)。各平面長(zhǎng)期無(wú)療效和有效組間阻塞率無(wú)統(tǒng)計(jì)學(xué)差異(P值0.05)。結(jié)論1.OSAHS患者DISE檢查VOTE評(píng)分明顯高于清醒時(shí)Muller's檢查,睡眠狀態(tài)的上氣道阻塞平面更多,阻塞程度更重。在評(píng)估舌根平面和會(huì)厭平面,DISE優(yōu)于Muller's檢查。BMI、AHI、最低血氧飽和度及平均血氧飽和度與VOTE評(píng)分中的阻塞嚴(yán)重程度關(guān)聯(lián)不明顯。2.對(duì)舌根平面的評(píng)估,藥物誘導(dǎo)睡眠內(nèi)鏡檢查優(yōu)于Friedman臨床分型及其中的舌背分級(jí)。高位舌背并不能預(yù)示舌根平面更容易出現(xiàn)阻塞。肥大的扁桃體提示口咽側(cè)壁平面的阻塞。3.運(yùn)用VOTE評(píng)分對(duì)藥物誘導(dǎo)睡眠內(nèi)鏡檢查結(jié)果進(jìn)行評(píng)估后,對(duì)于腭咽平面存在完全阻塞,同時(shí)口咽側(cè)壁平面存在阻塞的患者進(jìn)行手術(shù)后,其短期療效更好。對(duì)于經(jīng)藥物誘導(dǎo)睡眠內(nèi)鏡檢查指導(dǎo)的多平面手術(shù)長(zhǎng)期療效,考慮本組數(shù)據(jù)樣本量太少,需進(jìn)一步隨訪擴(kuò)大樣本量后,再進(jìn)一步探討睡眠內(nèi)鏡中VOTE評(píng)分與長(zhǎng)期手術(shù)療效的關(guān)系。
[Abstract]:Objective To evaluate the effect of surgical treatment on the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). However, the DISE examination lacks a unified standard for describing the observed results, and affects the evaluation of the location and the degree of obstruction of the DISE on the blocking part. In recent years, the foreign literature has proposed the VTE (velum, orophaynx, tonguebase, epiplotis) scoring system, which is used to record the results of the DISE test, but there is no similar study in the country. This subject is to use the VOTE scoring system to record the patient's upper airway obstruction in the sleep state and to compare the differences between the endoscopic Muller's and the Friedman's clinical typing. The relationship between the results of the VOTE score and the effectiveness of the multi-plane operation was analyzed by the analysis of the DISE. In this study, 56 patients with OSAHS were diagnosed by polysomnography, and Friedman's clinical typing was performed for each patient, and the Muller's examination and the drug-induced sleep-endoscopy were performed separately, of which 40 patients had the results of the video recording. The VOTE scoring system was used to describe the obstruction plane, the degree of obstruction and the blocking morphology of the upper airway observed during the endoscopy procedure. The differences between the two test results were compared with the DISE and Muller's, and the inter-patient BMI, AHI, The minimum blood oxygen saturation and the mean blood oxygen saturation were different. To compare the differences in the degree of airway obstruction between DISE and Friedman's clinical classification. Short-and long-term efficacy analyses were performed on patients with multi-plane surgery based on the DISE results. Results The first chapter: The results of the DISE indicated that 40 patients with OSAHS who had the result of the examination and video showed that the main upper airway obstruction was still in the pharynx plane, and the total occlusion was the main (90%), with the most common in the ring-like obstruction (95%). The total obstruction rate of the side wall of the oropharynx was 60%, and the total occlusion rate of the tongue was 17.5%. In the awake state, the muller's examination mainly observed the obstruction of the plane of the pharynx and the side wall of the oropharynx, and the total occlusion rate was 52.5% and 30%, respectively. According to the VOTE score, the scores of DISE in 40 patients were higher than those of the Muller's in the awake state, and there was a statistical difference (P <0.05). In the results of the DISE test, there was a statistically significant difference between the AHI value and the minimum blood oxygen saturation in the pharyngeal plane, partially blocked patients, and fully blocked patients (P <0.05). There was no statistical difference between the patients with oropharynx side wall, tongue root and epiglottic plane and different blocking degree (P <0.05). In the Muller's examination, there was no statistical difference in BMI, AHI, minimum blood oxygen saturation, and mean blood oxygen saturation among patients with different degrees of obstruction in each plane (P <0.05). In the second chapter, in the comparison of the clinical classification of DISE and Friedman, there was a statistical difference between the different tonsillectomy groups in 56 patients (P <0.05). There was no statistical difference between the different Friedman clinical classification groups in the lingual plane (P <0.05), and there was a statistical difference between the different Friedman's back grading groups (P <0.05). In the third chapter, there was a statistical difference between the short-term effect of the short-term effect on the side-side wall of the oropharynx and the effective group (P-value of 0.05). There was no statistical difference between the long-term efficacy of each plane and the effective group (P <0.05). Conclusion 1. The VISE in OSAHS patients was significantly higher than that of the Muller's in the awake state, and the upper airway obstruction plane was more in the sleep state and the degree of obstruction was more severe. The DISE is superior to the Muller's check in the evaluation of the lingual and epiglottic planes. BMI, AHI, minimum blood oxygen saturation, and mean blood oxygen saturation were not significantly associated with the severity of the obstruction in the VOTE score. For the evaluation of the hyoid plane, the drug-induced sleep-endoscopy was superior to the Friedman's clinical classification and the back grading of the tongue. the high-position tongue can not indicate that the tongue-root plane is more prone to blockage. The hypertrophy of the tonsils suggests a blockage in the plane of the pharyngeal wall. After the evaluation of the results of the drug-induced sleep endoscopy by the VOTE score, there was a complete blockage in the pharyngeal plane, and the short-term effect was better after the operation of the patients with the obstruction in the plane of the oropharyngeal wall. For the long-term effect of the multi-plane operation guided by the drug-induced sleep endoscopy, the relationship between the VOTE score and the long-term operation effect of the sleep endoscope is further discussed after the sample size of the data is too small and the sample size is expanded further.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R766.9
本文編號(hào)：2394384
[Abstract]:Objective To evaluate the effect of surgical treatment on the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). However, the DISE examination lacks a unified standard for describing the observed results, and affects the evaluation of the location and the degree of obstruction of the DISE on the blocking part. In recent years, the foreign literature has proposed the VTE (velum, orophaynx, tonguebase, epiplotis) scoring system, which is used to record the results of the DISE test, but there is no similar study in the country. This subject is to use the VOTE scoring system to record the patient's upper airway obstruction in the sleep state and to compare the differences between the endoscopic Muller's and the Friedman's clinical typing. The relationship between the results of the VOTE score and the effectiveness of the multi-plane operation was analyzed by the analysis of the DISE. In this study, 56 patients with OSAHS were diagnosed by polysomnography, and Friedman's clinical typing was performed for each patient, and the Muller's examination and the drug-induced sleep-endoscopy were performed separately, of which 40 patients had the results of the video recording. The VOTE scoring system was used to describe the obstruction plane, the degree of obstruction and the blocking morphology of the upper airway observed during the endoscopy procedure. The differences between the two test results were compared with the DISE and Muller's, and the inter-patient BMI, AHI, The minimum blood oxygen saturation and the mean blood oxygen saturation were different. To compare the differences in the degree of airway obstruction between DISE and Friedman's clinical classification. Short-and long-term efficacy analyses were performed on patients with multi-plane surgery based on the DISE results. Results The first chapter: The results of the DISE indicated that 40 patients with OSAHS who had the result of the examination and video showed that the main upper airway obstruction was still in the pharynx plane, and the total occlusion was the main (90%), with the most common in the ring-like obstruction (95%). The total obstruction rate of the side wall of the oropharynx was 60%, and the total occlusion rate of the tongue was 17.5%. In the awake state, the muller's examination mainly observed the obstruction of the plane of the pharynx and the side wall of the oropharynx, and the total occlusion rate was 52.5% and 30%, respectively. According to the VOTE score, the scores of DISE in 40 patients were higher than those of the Muller's in the awake state, and there was a statistical difference (P <0.05). In the results of the DISE test, there was a statistically significant difference between the AHI value and the minimum blood oxygen saturation in the pharyngeal plane, partially blocked patients, and fully blocked patients (P <0.05). There was no statistical difference between the patients with oropharynx side wall, tongue root and epiglottic plane and different blocking degree (P <0.05). In the Muller's examination, there was no statistical difference in BMI, AHI, minimum blood oxygen saturation, and mean blood oxygen saturation among patients with different degrees of obstruction in each plane (P <0.05). In the second chapter, in the comparison of the clinical classification of DISE and Friedman, there was a statistical difference between the different tonsillectomy groups in 56 patients (P <0.05). There was no statistical difference between the different Friedman clinical classification groups in the lingual plane (P <0.05), and there was a statistical difference between the different Friedman's back grading groups (P <0.05). In the third chapter, there was a statistical difference between the short-term effect of the short-term effect on the side-side wall of the oropharynx and the effective group (P-value of 0.05). There was no statistical difference between the long-term efficacy of each plane and the effective group (P <0.05). Conclusion 1. The VISE in OSAHS patients was significantly higher than that of the Muller's in the awake state, and the upper airway obstruction plane was more in the sleep state and the degree of obstruction was more severe. The DISE is superior to the Muller's check in the evaluation of the lingual and epiglottic planes. BMI, AHI, minimum blood oxygen saturation, and mean blood oxygen saturation were not significantly associated with the severity of the obstruction in the VOTE score. For the evaluation of the hyoid plane, the drug-induced sleep-endoscopy was superior to the Friedman's clinical classification and the back grading of the tongue. the high-position tongue can not indicate that the tongue-root plane is more prone to blockage. The hypertrophy of the tonsils suggests a blockage in the plane of the pharyngeal wall. After the evaluation of the results of the drug-induced sleep endoscopy by the VOTE score, there was a complete blockage in the pharyngeal plane, and the short-term effect was better after the operation of the patients with the obstruction in the plane of the oropharyngeal wall. For the long-term effect of the multi-plane operation guided by the drug-induced sleep endoscopy, the relationship between the VOTE score and the long-term operation effect of the sleep endoscope is further discussed after the sample size of the data is too small and the sample size is expanded further.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R766.9
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相關(guān)期刊論文 前4條
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，本文編號(hào)：2394384
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