The Study Of Pre-and Post-operative Of Nasal Ventilation Function In Patients With Severe OSAHS

ObjectiveTo investigate pre-and post-operative of nasal ventilation function of severe OSAHS patients in the clinical treatment.To research nasal ventilation function in severe OSAHS patients with palatopharyngeal and glossopharyngeal obstruction who only received throat operation.To study the changes of nasal ventilation function in severe OSAHS patients with nasal plane combined with palatopharyngeal and glossopharyngeal plane blocking after nasal cavity expansion surgery,while which will impact the condition assessment.Method126 healthy adults who accepted examinations from February 2011 to February 2013 were enrolled in this study as control group.They had no disease of rhinology or pharyngology.110 cases of severe OSAHS patients who were outpatients at the same period were enrolled in this study as observation group.By blocking the plane they were divided into:68 severe OSAHS patients without nasal obstruction as pharyngeal surgery group.They had palatopharyngeal and glossopharyngeal plane blocking,and were underwent coblation-assisting modified uvulopalatopharyngo-plasty combined with coblation-channeling of tongue(H-UPPP&CCT).42 severe OSAHS patients with nasal obstruction as nasal surgery group.They also had palatopharyngeal and glossopharyngeal plane blocking,and were underwent nasal cavity expansion surgery at first.A1 acoustic rhinometry(AR)was measured the minimum cross-sectional area(MCA),the distance of the minimal cross-sectional area to the nostril(DCAN)and the nasal volume from 0 to 5cm,2 to 5cm(V5,V2～5).NV1 rhinospirometer(RS)was mesured unilateral inspiratory capacity(IC)and expiration capacity(EC),and nasal partitioning ratio(NPR)could be calculated.At 75pa and Broms,NR6 rhinomanometry(RM)was measured unilateral nasal inspiratory resistance(IR)and nasal expiratory resistance(ER),the total bilateral nasal inspiratory and expiratory resistance(TIR,TER).Snoring index(SI),apnea-hypopnea index(AHI),the lowest oxygen saturation(LSaO2)and the average oxygen saturation(SaO2)were recorded by polysomnography(PSG).Preoperative and postoperative 6 months of observation groups were measured respectively by all the examinations,control group was measured respectively by AR,RS and RM.Statistical analysis by SPSS 17.0,P<0.05 was considered statistically significant.Result1 V5 and V2～5 increased,NPRe decreased,IR and ER decreased in postoperative pharyngeal surgery group compared with preoperative one(P<0.05).2 SI,AHI,LSaO2 and SaO2 had significant difference in postoperative pharyngeal surgery group compared with preoperative one(P<0.05).The cure rate was 16.18%,markedly effective rate was 39.71%,the effective rate was 23.53%(16 cases),inefficiency was 20.59%.The total effective rate was 79.41%.3 MCA,V5,V2～5 IC and EC increased,NPRi,NPRe,IR,ER,TIR and TER decreased in postoperative nasal surgery group compared with preoperative one(P<0.01).4 SI,AHI,LSaO2 and SaO2 in postoperative nasal surgery group had significant difference compared with preoperative one(P=0.000).The cure rate was 0%,markedly effective rate was 30.95%,the effective rate was 28.57%,inefficiency was 40.48%.The total effective rate was 59.52%.5 Compared with control group,MCA,V5 and V2～5 decreased,NPRi,NPRe,IR and ER increased in preoperative nasal surgery group(P<0.05).MCA,V5 and V2～5 increased,NPRi,NPRe,IR,ER,TIR and TER decreased in postoperative nasal surgery group(P<0.05).6 There was significant negative correlation was found between MCA,V5 and IR,ER(P<0.01).There was significant positive correlation was found between MCA,V5 and IC,EC(P=0.001 or P=0.000).7 At 75pa,there was significant positive correlation which was found between AHI and IR,ER,TIR,TER(P<0.05).Conclusion 1 Improving the upper airway collapse by pharyngeal surgery,nasal capacity in severe OSAHS patients without nasal obstruction could be enlarged,and nasal ventilation could be improved,which help to improve compliance and effectiveness of nasal continuous positive airway pressure in postoperative OSAHS patients,also suggest that some OSAHS patients with a slight nasal obstruction symptoms may not need to do nasal operation.2 Compared with control group,cross-sectional area and nasal volume decreased,while nasal partitioning ratio and unilateral nasal resistance increased in severe OSAHS patients with nasal obstruction,which prompted that bilateral nasal ventilation function declined asymmetrically.This could lead to pharynx cavity collapse,increase soft palate vibration.Under the influence of inflammation,upper airway mucosal hyperemia led to nasal volume decreased,which resulted in increasing nasal resistance.Therefore nasal obstruction and pharyngeal obstruction in OSAHS pathogenesis are complementary to each other.3 After nasal cavity expansion surgery,severe OSAHS patients with nasal obstruction were corrected nasal structure abnormalities,expanded nasal ventilation volume,restored nasal ventilation symmetrically,but do not relieved upper airway obstruction.4 In some severe OSAHS patients with nasal obstruction who had less effective treatment,the role of velopharyngeal or glossopharyngeal obstruction was larger in upper airway obstruction.The interaction of each blocking plane in the further development of the disease still need further study.5 If severe OSAHS patients after nasal cavity expansion surgery who had OSAHS symptoms persisted were not got further treatment,while they did not change long-term habit of mouth breathing,that might cause nasal chronic inflammatory response again,leading to upper airway mucosal congestion,nasal ventilation function decline.These patients might need to do pharyngeal surgery timely,or try to nasal continuous positive airway pressure treatment.6 Nasal volume decrease might be one of the factors of OSAHS pathogenesis.OSAHS causes were complex and diverse,which need to do more in-depth research.