上气道测压与Friedman分型在上气道阻塞平面判断中的相关性研究  

Clinical value of upper airway pressure measurement and Friedman staging system in preoperative evaluation for obstructive sleep apnea hypopnea syndrome

作　　者：田旭[1] 李五一[1] 霍红[1] 余蓉[1] 王剑[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院耳鼻咽喉头颈外科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2011年第8期622-627,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家“十五”科技攻关项目（2004 BA720A17）

摘　　要：目的通过比较上气道压力测定法与Friedman气道阻塞临床分型在阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopneasyndrome，OSAHS）患者术前评估判定阻塞平面中的作用，分析Friedman气道阻塞临床分型预测阻塞平面的价值。方法对103例有打鼾及白天嗜睡已经多道睡眠监测确诊为OSAHS患者进行Friedman气道阻塞临床分型后，同期应用ApneaGraph（AG）行整夜的睡眠监测和上气道压力测定，以下部阻塞层面（主要为舌后区）构成比分析Friedman气道阻塞临床分型与上气道压力测定所显示上气道阻塞部位的关系。结果根据Friedman临床分型、舌位高度分级（Friedman tongue position，FTP）、扁桃体分度分组，AG判断的下部阻塞构成比的差异有统计学意义（F值分别为13．876、7．655、10．207，P值均〈0．05）。两两比较，下部阻塞构成比在Friedman临床分型的Ⅳ型与Ⅰ、Ⅱ、Ⅲ型之间差异均有统计学意义（P值均〈0．01），且有随着分型级别增高，下部阻塞构成比也有增高的趋势；在FTP分级的2级与3、4级之间差异有统计学意义（P值均〈0．05），也有随着分级增高下部阻塞构成比增高的趋势；在扁桃体分度的4度与1度、2度、3度之间差异均有统计学意义（P值〈0．01或0．05）。结论Friedman临床分型，特别是其中的FTP分级与AG对下部阻塞的判定有相关性趋势，可以作为预测OSAHS患者睡眠时上气道阻塞平面的参考。Objective To evaluate the clinical value of localization of upper airway obstructive site with pressure measurements and Friedman staging system in preoperative upper airway reconstructive surgery for obstructive sleep apnea-hypopnea syndrome （ OSAHS）, and to evaluate the value of Friedman staging system in predicting the upper airway obstructive site. Methods One hundred and three patients with snoring, daytime sleepiness diagnosed as OSAHS by polysomnography were first classified using Friedman staging system, and then examined using whole night recording, including airway continuous pressure measurements （Apnea Graph, AG）. AG transducer catheter containing two pressure and two temperature sensors used for obstruction site determination and detection of apnea events during sleep. Obstructive sites were divided into upper （retropalatal region） or lower level （retroglossal region）. Using constituent ratio to reflect the obstructive proportion of different levels so as to find the correlation between Friedman staging system and localization of upper airway obstructive site with pressure measurements performed during sleep, and to evaluate the clinical value of Friedman staging system in predicting the severity of OSAHS. Results There was statistically significant difference in the constituent ratio of retroglossal obstruction determined by AG, according to Friedman staging system, Friedman tongue position （FTP） and tonsil size grading （F = 13. 876, 7. 655,10. 207 respectively, P 〈 0.05 ）. The constituent ratio of retroglossal obstruction between stage Ⅳ and Ⅰ , Ⅱ, Ⅲ （P 〈 0. 01 ） was significantly different. With the increasing of Friedman staging, the constituent ratio of retroglossal obstruction had the tendency of increasing. The constituent ratio of retroglossal obstruction between FTP grade 2 and grade 3, grade 4 （P 〈 0. 05 ） was significantly different.With the increasing of FTP grading, the constituent ratio of retroglossal obstruction had the tendency of increas

关 键 词：睡眠呼吸暂停 阻塞性 测压法 气道阻力 咽 

分 类 号：R766[医药卫生—耳鼻咽喉科]