阻塞性睡眠呼吸暂停低通气综合征患者软腭的动态磁共振研究  

Study of Cine-MRI for the soft palate in patients with obstructive sleep apnea hypopnea syndrome

作　　者：钱备[1] 汤光宇[2] 刘勇[2] 姚冀平[2] 

机构地区：[1]同济大学附属第十人民医院耳鼻咽喉科,上海200072 [2]同济大学附属第十人民医院放射科

出　　处：《临床耳鼻咽喉头颈外科杂志》2010年第24期1108-1111,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者清醒和自然睡眠2种状态下软腭的运动情况和引起阻塞的原因。方法:2007-05-2007-12到同济大学附属第十人民医院耳鼻咽喉科就诊并经睡眠问卷调查表、临床体检及多导睡眠监测仪证实的OSAHS患者16例,分别在清醒和自然睡眠状态下进行上气道正中矢状位动态磁共振成像(Cine-MRI),要求MRI检查前夜保持清醒。将2种状态下Cine-MRI正中矢状位成像导入电脑,测量软腭的形态变化、前后摆动角度和长度。采用配对t检验统计学分析清醒与自然睡眠状态下各径线值和角度差异。结果:清醒状态下软腭的形态有正常形、镰刀形、鱼钩形和倒S形,主要以向后飘动方式和前后径增宽引起阻塞(腭悬距P>0.05,腭腹夹角P<0.05,腭背夹角P<0.01,腹背夹角差P<0.01),阻塞层面主要在软腭后区。自然睡眠状态下软腭的形态除有清醒状态下的形态外,更有感叹号形、竖条形等,主要以向下增长及前后径增宽的方式引起阻塞(腭悬距P<0.01,腭腹夹角P>0.05,腭背夹角P>0.05,腹背夹角差P<0.01),阻塞层面主要在舌后区。结论:OSAHS患者自然睡眠状态下较清醒状态下软腭的形态变化更多样,软腭引起上气道阻塞的层面更深,阻塞主要原因不同,清醒状态下不能代表睡眠状态下的软腭变化。Objective：To study dynamic change and pathophysiology of airway obstruction of the soft palate in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） during wakefulness and natural sleep.Method：Sixteen patients who were diagnosed as OSAHS by sleep questionnaires,medical examination and polysomnography were enrolled in this study in Shanghai Tenth People＇Hospital from May to December during 2007.All patients were requested to keep awake prior to examination.Sequential midline sagittal images of the upper airway were obtained during awake and asleep state with Cine-MRI and been transmitted to portable computer.Morphologic change of the soft palate,the anterior-posterio pendulum angle of the soft palate,the anteroposterior diameter and the length of soft palate were measured.Statistical analysis was performed with paired t-test.Result：During wakefulness：soft palate caused obstruction by floating backwards and widening anteroposterior diameter（distance between hard palate and uvula P0.05,included angle of hard palate and segmental vente of uvula P0.05,included angle of hard palate and segmental dorsum of uvula P0.01,difference of included angle P0.01）.Main obstruction site was on retropalate region.During natural sleep：soft palate caused obstruction by lengthening down and widening anteroposterior diameter（distance between hard palate and uvula P0.01）,included angle of hard palate and segmental vente of uvula P0.05,included angle of hard palate and segmental dorsum of uvula P0.05,difference of included angle P0.01）.Main obstruction site was on retroglottal region.Conclusion：Morphologic change of soft palate in patients with OSAHS is multiple,and level of obstruction is deeper during natural sleep than during wakefulness.Main reason of airway obstrucion is distinct during different state.The obstruction of upper airway of patients with OSAHS during wakefulness can＇t replace that during natural sleep.

关 键 词：睡眠呼吸暂停低通气综合征 阻塞性 软腭 多道睡眠描记术 磁共振成像 

分 类 号：R814.46[医药卫生—影像医学与核医学]