咽后壁瓣咽成形术相关通气功能障碍及应对

doi:10.7518/gjkq.2024028

摘要/Abstract

摘要：

咽后壁瓣咽成形术通过机械封堵的形式矫正腭咽闭合不全，获得语音改善的同时牺牲部分通气功能，存在较高通气功能障碍风险。有效预防和处理通气并发症对咽后壁瓣患者手术安全及生存质量至关重要，是序列治疗不容忽视的重要环节。然而，咽瓣术后通气障碍发生的相关因素及应对措施等尚未明确。本文围绕咽后壁瓣咽成形术通气并发症的流行病学特征、病理发生机制、评估诊断方法和防治应对手段展开讨论，旨在为进一步优化气道问题相关的唇腭裂序列治疗提供参考。

关键词: 腭裂, 腭咽闭合不全, 咽成形术, 鼻通气, 睡眠呼吸暂停

Abstract:

Posterior pharyngeal flap pharyngoplasty corrects velopharyngeal insufficiency by mechanically occluding the airway. Speech is improved in sacrifice of partial ventilation, increasing perioperative and long-term airway risks. Effective prevention and intervention of airway complications are critical to patient safety and life quality and cannot be ignored in sequence therapy. However, pharyngeal flap-related airway issues await further clarification. This paper focuses on the epidemiological characteristics, pathological mechanism, evaluation and diagnosis methods, and prevention and treatment of ventilation complications of posterior pharyngeal flap pharyngoplasty to provide reference for further optimization of the sequence treatment of cleft lip and palate related to airway problems.

Key words: cleft palate, velopharyngeal insufficiency, pharyngoplasty, nasal ventilation, sleep apnea

中图分类号:

R782.2

李亚楠,石冰,李精韬. 咽后壁瓣咽成形术相关通气功能障碍及应对[J]. 国际口腔医学杂志, 2024, 51(2): 233-240.

Yanan Li,Bing Shi,Jingtao Li. Management of ventilatory dysfunction associated with posterior pharyngeal flap pharyngoplasty[J]. Int J Stomatol, 2024, 51(2): 233-240.

图/表 2

表 1

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项目	n	诊断方法		发生率	参考文献
项目	n	主观	客观	发生率	参考文献
Hirschberg（2012）	1 064	-	多导睡眠监测	6.2%严重鼻气道阻塞 0.5%OSA	[32]
Rochlin（2021）	670	-	分析数据库已诊断数据	7.2%OSA	[33]
Ysunza（1993）	585	-	多导睡眠监测和鼻咽镜	2.6%OSA	[34]
Cole（2008）	222	-	多导睡眠监测	8%氧饱和度下降 3.33%OSA	[6]
Reddy（2016）	133	-	血氧饱和度监测	1.5%	[35]
Yamashita（2008）	58	自我报告睡眠通气障碍事件	-	55%（术后5个月）	[28]
Yamashita（2008）	58	自我报告睡眠通气障碍事件	-	36%（术后1年）
Griner（2013）	18	-	多导睡眠监测	50%	[7]
de Blacam（2022）	109	-	多导睡眠监测	6.4%OSA	[36]
Yamaguchi（2016）	38	医生评估	-	18.4%打鼾 5.3%睡眠障碍
Yamaguchi（2016）	38	-	多导睡眠监测	2.6%OSA	[37]
Liao（2002）	38	-	多导睡眠监测	成人90%OSA 儿童93%OSA	[31]
Luo（2020）	30	主观量表问卷调查	-	60%鼾症 33.3%通气障碍	[14]
Trabelsi（2021）	18	-	呼吸多功能图	11%OSA	[38]
Orr（1987）	10	-	多导睡眠监测	90%OSA	[30]

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