The sleep is pressing the therapeutic _'s treatment that is kept in touch with by the nose before breathing and suspending the syndrome skill

The sleep is pressing the therapeutic _'s treatment that is kept in touch with by the nose before breathing and suspending the syndrome skill
The sleep is pressing the treatment that is kept in touch with by the nose before breathing and suspending the syndrome skill

Magazine of Chinese E.N.T. Department Vol. 33 of number 2 of 1998 Clinical research

Author: Jiang Hong Ni DaoFeng Li May Day Gao ZhiQiang Zhang LianShan

Unit: 100730 Beijing China Concord Medical Science University BJ Union Hospital E.N.T. Department of Chinese Academy of Medical Sciences

Keyword: Breathe and suspend syndrome in sleep; Oxygen sucks the treatment; Many dishes of sleeps copy and remember the skill; Uvula palate swallow shaping skill; Tracheostomy skill

[Summary ] PurposeTry out and press and keep in touch with (nasal continuous positive airway pressure, NCPAP) by the nose Substitute and breathe and suspend syndrome (obstructive sleep apnea syndrome, OSAS) to the severe blockade sleep Patient competent the intersection of uvula and palate swallow shaping skill The preventative tracheostomy skill ago, prevent from cause fatal character complication in the skill and postoperatively.Method The patient is severe OSAS of treatment of competent UPPP, regards 52 patients in November of 1991 - April of 1994 as the control group; 42 patients, in order to treat group in May - 1996 of 1994. Control group and last group from the whole night 7 hour if you can't lead more sleep appearance, monitor (polysomnography, PSG) Made a definite diagnosis of, it had no significance that the main parameter is compared with the difference before two groups of treatments. 7 under control group, move ahead preventative tracheostomy on the intersection of UPPP and skill; Breathing stops in another skill suddenly, urgent tracheostomy. And treat 9 similar serious patients in the group and accept NCPAP treatment before UPPP skill. Pressing competence of NCPAP therapentic instrument is 1.16kPa (11.85cmH equally2O),Treat time for average 9 days, will treat the group NCPAP before and after treatment PSG every important index will be observed and compared.Result After NCPAP treatment, treat group to be most long to breathe, suspend time, drop 24.36 seconds such as 15.42 to 77.42 second by 84.46 , breathe the disorder index by 66.01 14. 03 is dropped to 2.43 8.26, the most hypoxic degree of saturation is improved from 53.15 14.67 to 87.69 7.11. Treat, breathe and suspend the number of times to obviously reduce or disappear, the sleep structure is improved, the minimum arterial oxygen saturation is raised, UPPP skill goes on under local anaesthesia smoothly, there is not complication, the tracheostomy skill that have not done.Conclusion Preventative tracheostomy skill before NCPAP treatment can substitute some severe OSAS patient UPPP skills.

Preoperative nasal continuous positive airway pressure treatment as substitute for protective tracheo stomy in severe obstructive sleep apnea syndrome Jiang Hong,Ni Daofeng,Li wuyi, et al. Peking Union Medical College Hospital, Beijing 100730

[Abstract] Objective Preoperative nasal continuous positive airway pressure(NCPAP) treatment was used as a substitute for protective tracheostomy before UPPP surgery in 42 patients wit h severe obstructive sleep apnea syndrome(OSAS) from 1994 to 1996.Methods Fifty-two patients operated on three years before this period served as control group. All cases were diagnosed as severe OSAS by polysomnography(PSG) .Results There were no statistical difference in main parameters between two groups. Seven cases in the control group underwent protective tracheostomy whose apnea and hypopnea index(AHI) was 28.4- 83.5 and lowest saturation oxygen (SaO2)were 7%- 32%. One patient underwent emergency tracheostomy due to life-threatening situation during uvulopalatophar yngoplasty(UPPP) . There were 9 similarly severe cases who did not undergo protective tracheostomy in NCPAP treatment gr oup. All patients underwent preoperative 5- 20 day NCPAP treatment in treatment group. The average positive pressure was 1.16 kPa(11.85 cmH2O). There were significant difference in main parameters between the two groups. The AHI, SaO2 and sleep structure were evidently improved. UPPP was safely performed without protective tracheostomy and any complications in all patients with NCPAP treatment.Conclusion this result implys that NCPAP treatment could be used as a substitute for protective tracheostomy bef ore UPPP in severe oSAS.

[Key words]Sleep apnea syndromes Oxygen inhalation therapy Polysomnography Uvulopalatopharyngoplasty Tracheotomy

Breathe and suspend syndrome (obstructive sleep apnea syndrome, oSAS) in obstructive sleep As a kind of sleep disease, have already been widely paid attention to day by day. Uvula palate swallows shaping skill (uvulopala-topharyngoplasty, UPPP) Swallow the shaping skill (palatopharyngoplasty, PPP) with the palate Treat main surgical means of OSAS since the eighties, domestic to generally launch, and there is better curative effect. But UPPP is not absolutely safe, especially besides general complication to the severe OSAS patient, domestic and foreign already there are reports that the case dies in a skill and postoperatively in succession[1,2]. The preventative tracheostomy skill is to prevent this kind of most effective method to cause fatal character complication. Because there are a great deal of factors in the tracheostomy skill it is difficult to be accepted by the patient. Our department is trying out to press and keep in touch with (nasal continuous positive airway pressure, NCPAP) continuously through the nose before 1994- 1996 UPPP skill Preventative tracheostomy, had made better result, summarized the report as follows before replacing the skill.

Target and method

A materials

1.Control group: 1991- Severe OSAS patient of hospital treatment in April of 1994, amounts to 52. It is men, 26-63 years old, height 161- 184 cm, weight 72- 94 kg, 30 persons who amalgamates hypertension, heart disease person are 18.

2.Treat the group: 1994- In hospital in 1996 the severe OSAS patient of the operation amounted to 42. 40 men, 2 women, 12-65 years old, height 150- 186 cm, weight 67- 115 kg, 24 persons who amalgamates hypertension, heart disease person are 18.

Second, monitor method and diagnostic standard[3]

Treated the group NCPAP before treatment and all lines led more sleep appearances and monitored in the whole 7 hours of night before two groups of UPPP skillsed (polysomnography, PSG) ,And analyzed the sleep according to the standard that Rechtschaffen,etc. was put forward of 1968, the data were by the computing of computer. Breathe the disorder index (AHI) with degree in clinical condition With the most hypoxic degree of saturation of sleep (SaO2)It is the index, AHI is greater than or equal to 51 or SaO2It is severe to be less than or equal to 79%[4].

Third, therapeutic method

NCPAP treats 42 patients of group and all adopts NCPAP therapentic instrument that two institutes 4 of spaceflight department made, type SZD-1, power 30W. Among them 30 patients regulate NCPAP therapentic instrument and press competence under the circumstances that PSG monitor while using for the first time, the breath when can dispel various positions and every sleep until the pressure reaches is suspended[5] .

The average pressure that NCPAP therapentic instrument of this group adopts is 1.16 kPa (12 cmH2O),Use NCPAP to treat for 9.0 days (5- 20 day) on average before 28 UPPP skills ; Other 2 are used for 3 months, 2 years separately; 12 do when the treatment due to many kinds of reasons PSG monitor pressure, according to AHI and the lowest SaO at the time of the sleep2Regulate the pressure gradually, make it not only can dispel the sleep to breathe and suspend make patient's ability receive but also[6],The range of its pressure is in 0.78- 1.18 kPa (8- 12 cmH2O),Use NCPAP to treat for 7.8 days (5- 13 day) on average UPPP skill that and then walk.

Fourth, statistics are dealt with

Adopt t test to compare, uses s expresses.

Result

First, treat the major indicators change of the previous, back PSG

It lists in the attached list to treat the major indicator that the group NCPAP monitors with the control group PSG before and after treatment, and will treat the parameter before treatment of the group compared with control group, NCPAP parameter before and after treatment be compared.

Attached list Two groups of OSAS patient PSG every indexes measure the result





Project

Control group

NCPAP treats the group





Before treating

After treating





Record time (divide)



375.34 94.68



403.26 27.81

392.02 57.12





Awaken time (divide)

46.76 37.89

37.33 27.69

37.93 20.04





Non- fast eyes are moved and slept

Sleep for time (%)





One



47.95 17.03



33.89 15.66

20.90 10.00*





2One

42.25 17.22

56.45 15.26

49.96 12.74





+

2.17 3.80

2.08 4.77

13.72 16.98*





The eyes move the time of sleep (%) fast

9.59 14.72

7.11 3.73

15.79 5.49**





Breathe and suspend time (second) longest

66.27 29.87

84.46 77.42

15.42 24.36**





It is low to keep in touch with the index

42.74 25.00

25.11 21.94

0.34 0.79**





Breathe and suspend the index

27.38 20.55

43.23 19.3

2.90 8.23**





Breathe the disorder index

66.09 20.18

66.01 14.03

2.43 8.26**





Degree of saturation of oxygen (%) while waking up

93.82 4.81

94.27 1.85

95.27 1.85





The most hypoxic degree of saturation (%) of sleep

57.98 11.37

53.15 14.67

87.69 7.11**





SaO2(%)

41.33 13.07

42.80 14.37

7.50 7.44**





Note: SaO2=Degree of saturation of oxygen - most hypoxic degree of saturation of sleep while waking up; *P< 0.01 ; **P< 0.001

Can see two groups of condition severity from the attached list similarly, but treat the group after NCPAP treatment every index is improved notably.

The patient AHI of 7 tracheostomy is 28.4- 83.5 in the control group, the lowest SaO2It is 7%- 32%. Treat 9 similar patients in the group.

Second, subjective symptom

42 patients are through NCPAP treatment, subjective symptom is obviously improved, sound of snoring of sleep totally disappears, it is dispelled that sleepy in the daytime, energetic, have a headache and take a favorable turn.

Third, operation situation

1.Control group: Suffocate at the time of the sleep at night for 7 severe OSAS patient UPPP skill's preventative tracheostomy skills of moving ahead, one, already in local the intersection of hospital and competent the intersection of tracheostomy and skill, enter the our academy 40 days while being postoperative. Among them a complicated lung is infected with by UPPP skill of walking after the treatment of internal medicine department. The tape is in charge of time as 50.8 days (14- 195 day) on average before the skill ,The postoperative tape on average is in charge of time as 11.4 days (5- 30 day) .

2.Treat the group: 40 patients pass 5- NCPAP finish the intersection of UPPP and skill (another 2 NCPAP treat time 2 years and 3 months respectively) smoothly under local anaesthesia after the treatment 20 day . 16 attentive electricity guard and finish under blood and oxygen saturation lever is monitored among them. Have one routine preventative the intersection of tracheostomy and skill, even if NCPAP AHI is 99.4 before treatment, SaO2It is 28% that have not made tracheostomy skill either. UPPP appear complication while being postoperative in the skill. Patient's postoperative symptom is obviously improved.

Discussion

UPPP is a main surgical means to treat OSAS, and the severe OSAS patient implements UPPP greater danger occasionally[7,8],Already had in a skill both at home and abroad, the postoperative report which presents the death[1,2]. The preventative tracheostomy skill is to prevent this kind of most effective method to cause fatal character complication. But there are certain danger and serious complication in the tracheostomy skill, and bring economy, life and psychological burden to patient, and attend to the inconvenience, language obstacle, difficult to accept by most patients.

This group of materials prove NCPAP substitutes a better method of the preventative tracheostomy skill at present. Sullivan,etc. in 1981[9]Report NCPAP can stop breathing and suspending to treat OSAS, improves degree of saturation of oxygen, improve patient's symptom at first. The therapeutic principle department of NCPAP uses an air pump, the air is linked with patient by the nose face guard after filtering, wet and melting, while breathing independently, in the end of breathing in exhale and inhale in the course entirely, construct it by pressing in the angry way of a certain degree artificially, thus prevent the angry way from withering, increase the residual gas of function, improve the complying with of the lung, reduce the consumption of the breathing function, airway resistance may also be improved. Spread into and feedback function, also can make it increase not to have angry dishes of open the intersection of skin and a group of function through wall of the chest and nervus vagus, make upper angry way keep open[10]. Foreign report, the postoperative OSAS patient UPPP carries on NCPAP treatment at once, can reduce or prevent from because of the intersection of wound and some swelling, edema and use, ease pain medicine and postoperative complication that cause while being postoperative. This group of materials prove the breath of the person who is treated future trouble by NCPAP suspends the number of times to obviously reduce or disappear, the sleep structure is improved. The treated the patient chemosensitive receptor sensitiveness is improved, keep in touch with and drive strengthening, impel the keeping in touch with amount of alveolus to increase, blood and oxygen saturation lever is raised, the myocardium blood supply increases, the heart and lungs function gets the improvement of a certain degree, hypertension, arrhythmia caused by OSAS get the correction to a certain extent, have improved a patient to the tolerance of the operation, has reduced and caused the emergence of fatal character complication in UPPP skill and postoperatively.

NCPAP clinical indication that uses is: The obstructive sleep is breathed and suspended or the centre sleep is breathed and suspended; OSAS amalgamates chronic illness of the heart and lungs; Prepare before the severe OSAS patient UPPP skill; Unwilling to undergo an operation the intersection of OSAS and patient of treatment. In addition, patient with the obstructive disease should use the nose after curing. In the course of using NCPAP, it is the key to making and treating success to choose appropriately to press competence. Our experience is, the patient will feel that it is uncomfortable to feel oppressed when the pressure is too great, and the pressure is on the low side, can't totally dispel the obstructive sleep to breathe and suspend. NCPAP pressure value determine, should go on under the circumstances that PSG monitors for the first time when the treatment. In addition the face guard should be suitable, should stick to the skin and does not leak gas closely, let the patient feel comfortable, it is unlikely to blow and injure the skin around of face guard because the gas ease leak.

The situation that can't totally substitute the tracheostomy skill is as follows, the patient can't tolerate NCPAP treatment; Sober occasionally the intersection of hypoxemia and disease, serious heart and lungs complication, even breathe the patient that circulatory failure existsing; PSG measures the person who doesn't have obvious improvement after NCPAP treatment. Research on the problems in this respect still need to do to be further.

Will wither Internal medicine department of BJ Union Hospital breathes the precious professor's guidance of us of a group of yellow mats

References

1 Fairbanks E. Uvulopalatopharyngoplasty complications and avoidance strategies.Otolaryngol Head Neck Surg,1990,102:239-245.

2 Fan promise the people. The shaping operation death of soft palate of down uvula of general anesthesia is one. Clinical ear nose throat magazine, 1993, 7:112-113.

3 yellow mats are valued highly, Wu Quan has, Li LongYun,etc.. Lead clinical practice of the sleep picture more. Chinese internal medicine magazine, 1991, 30:758-760.

4 Bone RC, Pantjker RB, Mathhay RA, et al. Pulmonary and critical care medicine. v 2. Chicago: Mosby Year Book Inc, 1994.9-12.

5 Ronald RG. Obstructive sleep apnea, Throax, 1995,50:1106-1113.

6 Waldhorn RE. Attended home titration of NCPAP therapy for OSA.Chest, 1993; 104:1707-1710.

Unless 7 Li more than five, unless Zhang LianShan, at king frank,etc.. OSAS encloses operation period complication. Ear nose throat - surgery of neck, 1995, 2:21-23.

Unless last mountain, BoJun Wei 8 pieces, lose king,etc.. Serious getting obstructive disease sleep breathe, suspend the intersection of syndrome and preventative adaptation card of tracheostomy in front of the skill. The magazine of Chinese E.N.T. Department, 1995, 30:138-139.

9 Sullivan CE, Issa FG. Reversal of obstructive sleep apnea by continuous positive airway pressure applied through thenares.L ancet, 1981,1:862-865.

Unless that mat value highly in 10, unless YongXing Xu, have Quan Wu,etc.. The nose of OSAS foot-path is pressing and keeping in touch with and treating OSA. Chinese tuberculosis and breathing the magazine, 1991, 14:225-227 continuously. (Accept the draft: 1997-05-27 Build, answer: 1998-01-10)
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