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鼻窦手术后立即恢复气道正压治疗：一项前瞻性对照多中心研究。

Immediate Resumption of Positive Airway Pressure Following Sinus Surgery: A Prospective Controlled Multicenter Study.

临床研究鼻科IF 2.9Q1

文献信息

PMID42867257
原文在 PubMed 查看原文 ↗
发表日期2026
作者Garret Choby
查看其他 10 位作者

Jose L Mattos；Erin K O'Brien；Devyani Lal；Michael J Marino；Spencer Payne；Carlos N Pinheiro-Neto；Nicholas R Rowan；Anthony Tang；Eric W Wang；Janalee Stokken

作者单位Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
查看其他 5 条单位信息

Department of Otolaryngology, Head and Neck Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA.；Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.；Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA.；Department of Otolaryngology, Head and Neck Surgery, New York University, New York, New York, USA.；Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.

期刊Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
SCI 分区Q1
IF2.9
研究类型临床研究 · 临床
所属专科鼻科

中文摘要

目的： 围手术期未经治疗的阻塞性睡眠呼吸暂停（OSA）会带来显著的心肺风险。然而，许多耳鼻喉科医生因担心鼻出血、黏膜损伤和伤口愈合问题，而在功能性内镜鼻窦手术（FESS）后推迟恢复气道正压（PAP）治疗。因此，本研究的目的是评估接受FESS的OSA患者立即恢复PAP治疗的情况。
研究设计： 多中心前瞻性对照研究。
地点： 学术医疗中心。
方法： 前瞻性纳入有OSA病史并接受PAP治疗、计划进行FESS的患者（OSA/PAP组），以及一组非OSA的FESS患者作为对照组（非OSA组）。OSA/PAP组患者在术后第0天或第1天恢复PAP治疗。主要结局是Lund-Kennedy内镜评分（LKES）的变化；次要关注结局包括术后SNOT-22评分、匹兹堡睡眠质量指数（PSQI）评分、并发症和鼻出血严重程度评分的变化。
结果： 共纳入100例患者，其中49例在OSA/PAP组，51例在非OSA组。在多变量校正模型中，与对照组相比，早期恢复PAP与术后第1次随访（POV1）或第2次随访（POV2）时更高的LKES、更高的SNOT-22评分或更高的术后鼻出血评分均无独立关联。未发生PAP相关并发症，如眶气肿或颅内积气。
结论： 在接受FESS的OSA患者中，早期恢复PAP似乎与术后内镜评分、生活质量评分恶化或术后鼻出血风险增加无关。

英文摘要

OBJECTIVE: Untreated obstructive sleep apnea (OSA) in the perioperative period confers significant cardiopulmonary risk. However, many otolaryngologists defer restarting positive airway pressure (PAP) therapy following functional endoscopic sinus surgery (FESS) due to perceived risk of epistaxis, mucosal injury, and wound healing. Thus, the objective of this study was to evaluate the immediate resumption of PAP therapy in OSA patients undergoing FESS.
STUDY DESIGN: Multicenter prospective controlled study.
SETTING: Academic medical centers.
METHODS: Patients with a history of OSA on PAP therapy scheduled for FESS were prospectively enrolled (OSA/PAP group) along with a control group of non-OSA FESS patients (non-OSA group). Patients in the OSA/PAP group restarted PAP therapy on post-operative Day #0 or #1. The primary outcome was change in Lund-Kennedy endoscopic scores (LKES); secondary outcomes of interest included change in post-operative SNOT-22 scores, Pittsburgh Sleep Quality Index (PSQI) scores, complications, and epistaxis severity scores.
RESULTS: A total of 100 patients were enrolled, of whom 49 were in the OSA/PAP group, and 51 were in the non-OSA group. In multivariate adjusted models, early PAP resumption was not independently associated with higher LKES compared to the control group at POV1 or POV2, higher SNOT-22 compared to the control group at POV1 or POV2, or higher postoperative epistaxis scores compared to the control group. There were no PAP-related complications such as orbital emphysema or pneumocephalus.
CONCLUSION: Early resumption of PAP in OSA patients undergoing FESS does not appear to be associated with worsened post-operative endoscopic scores, quality-of-life scores, or an increased risk of post-operative epistaxis.