呼吸面罩内压力变化对阻塞性睡眠呼吸暂停低通气综合征患者上呼吸道形态的影响  

The effects of pressure level in veil on upper airway in patients with obstructive sleep apnea hypopnea syndrome

作　　者：李树华[1] 高丽[1] 邹明宇[2] 曲胜[2] 石洪金[1] 董卫东[1] 邹连贵[1] 

机构地区：[1]解放军沈阳军区总医院耳鼻咽喉科,沈阳110016 [2]解放军沈阳军区总医院放射诊断科,沈阳110016

出　　处：《临床耳鼻咽喉头颈外科杂志》2008年第15期673-677,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家十五科技攻关计划资助项目(No:2004BA720A17)

摘　　要：目的:探讨呼吸面罩内压力变化对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者和正常人上呼吸道形态的影响。方法:采用16排螺旋CT自鼻咽顶部到声门之间的区域进行连续扫描,应用图像工作站测量软腭后区、悬雍垂区、舌后区和会厌后区的气道横截面积、左右径和前后径。对35例正常对照者和46例OSAHS患者分别行面罩内压力为0kPa和0.784kPa状态下的CT扫描,比较正常对照者和OSAHS患者间在各种条件下上呼吸道各测量指标的差异。结果:在面罩内压力相同的条件下,OSAHS患者上呼吸道CT测量的多数指标明显小于对照组(P<0.05或P<0.01);对照组和OSAHS患者上呼吸道多数测量指标在0.784kPa正压条件下较0kPa时有明显增加(P<0.05或P<0.01),其中对照组的增加幅度明显大于OSAHS组(P<0.05或P<0.01);以35例对照者确定面罩内压力由0kPa增加到0.784kPa时上呼吸道软腭后区、悬雍垂区、舌后区和会厌后区横截面积增加的最小正常值为标准,将46例OSAHS患者分为上气道正常扩张的17例和扩张度低于正常的29例,在0kPa下这2组患者上呼吸道CT测量指标差异无统计学意义(P>0.05);而在0.784kPa条件下,前者的上呼吸道多项测量指标均大于后者(P<0.05或P<0.01)。结论:面罩内压力的增加可以在不同程度上导致OSAHS患者和对照者上呼吸道的扩张,其中OSAHS患者的扩张程度明显小于对照者;OSAHS患者上呼吸道扩张程度较小的原因与其上呼吸道存在解剖性狭窄和咽壁本身的可扩张性减弱有关。Objective：To observe the effects of pressure level in veil on upper airway in patients with obstruc tive sleep apnea bypopnea syndrome（OSAHS） and normal adults. Method：We scaned the upper airway from roof of nasopharynx to glottis with SIMENS 16 layer spiral CT scanner. The area and the dimensions of palate, uvula, and the region after lingua and epiglottis were measured by application of image work station. Forty-six patients with OSAHS and 35 normal adults were scaned by CT at 0 kPa water column and 0. 784 kPa water column pressures in face mask, respectively. Result：The area and inner diameter of OSAHS patients＇ upper airways were less than those of normal adults at the same pressure in face mask. The area and inner diameter of upper airway at the pressure of 0. 784 kPa water column were more than those at 0 kPa water column in both OSAHS patients and normal adults, and the increased extent of normal adults were more than those of OSAHS patients. We measured the minimum increased normal Cross sectional area of palate, uvula, and the region after lingua and epiglottis when the pressure in the mask increased from 0 kPa to 0. 784 kPa, and we made it as the standard. The 46 OSAHS patients were sorted into 17 cases （group 1） with normal dilation and 29 cases （group 2） with less dilation in such standard. There was not significant difference between the two groups at 0 kPa pressures in area and inner diameter, but the area and inner diameter of group 1 were more than those of group 2 at 0. 784 kPa pressure. Conclusion：The increased pressure in face mask would lead to upper airway dilation both in OSAHS patients and normal adults, and the dilated extents of normal adults were significant more than those of OSAHS patients. The less dilation of OSAHS may be duo to anatomic constriction and some pharynx wall pathological changes.

关 键 词：睡眠呼吸暂停低通气综合征 阻塞性 体层摄影 X线计算机 上呼吸道 持续正压通气 

分 类 号：R563.8[医药卫生—呼吸系统]