阻塞性睡眠呼吸暂停综合征患者上气道的MRI研究  

MRI evaluation of the upper airway in patients with obstructive sleep apnea syndrome

作　　者：张红蕾[1] 李传福[1] 林忠辉[2] 

机构地区：[1]山东医科大学附属医院放射科,济南250012 [2]山东医科大学耳鼻喉科学重点实验室

出　　处：《中华放射学杂志》2000年第3期191-195,共5页Chinese Journal of Radiology

摘　　要：目的　观察清醒状态下阻塞性睡眠呼吸暂停综合征 (OSAS)患者与正常对照组上气道及周围软组织的变化 ,并在睡眠状态下应用MRI动态扫描对阻塞部位进行定位 ,探讨OSAS的发生机制及MRI的应用价值。方法　应用MRI对 2 3例经多导睡眠监测 (polysomnography ,PSG)确诊的OSAS患者及 30例无打鼾的健康成人进行上气道检查 ,于轴面图像测量软腭后区 (retropalatalregion ,RP区 )、舌根后区 (retroglossalregion ,RG区 )和会厌区 (epiglottalregion ,EPG区 )的气道截面积 ,各区前后、左右径及其比值 (AP/L) ,各区咽侧壁、咽后壁软组织厚度 ,RP区咽旁间隙 (lateralparapharyngealfatpad ,LPFP)截面积 ,于正中矢状面图像测量软腭厚度、长度及截面积 ,对两组各项检查指标进行统计学分析。对 15例患者在诱导入睡后出现呼吸暂停时行MRI动态扫描 ,观察分析RP、RG、EPG区的阻塞情况 ,并进行定位。结果　OSAS患者RP、RG区气道截面积分别小于对照组 ;RP、RG、EPG区AP/L及咽后壁厚度、RP区LPFP截面积、RG区咽侧壁厚度、软腭截面积、厚度和长度均大于对照组。 15例睡眠患者中 ,3例仅出现RP区阻塞 ,2例仅出现RG区阻塞 ,10例RP、RG区均发现阻塞。通过观察MR图像 ,可以对阻塞原因作出初步分析。Objects To investigate the mechanisms of obstructive sleep apnea syndrome (OSAS) through observing the upper airway caliber and the corresponding pharyngeal wall of OSAS patients with MRI and to investigate the site of obstruction during sleep by using MRI dynamic scan. Methods Twenty three cases of OSAS patients proved by polysomnography (PSG) were examined with MRI. The cross sectional area of retropalatal region (RP), retroglossal region (RG), epiglottal region (EPG) and the lateral parapharyngeal fat pad (LPFP) of RP region was calculated. The thickness of bilateral and posterior pharyngeal wall and other indices were also measured. 30 nonsnoring age matched normal subjects were selected as the control group. 15 patients underwent turbo field echo (TFE) T 1 weighted imaging during sleep. The images of RP, RG, and EPG were analyzed. Results In OSAS group, the cross sectional area of RP and RG regions was smaller than that of the control group. The A P/lateral ratio in RP, RG, EPG region, the cross sectional area of LPFP and the thickness of the posterior pharyngeal wall of RP, RG and EPG region were statistically larger than that of the control group. Midsagittal MR images show the length, thickness and cross sectional area of the palate in patients group were larger than that of control group. During sleep, the RP region was obstructed in 3 of the 15 cases and the RG region was obstructed in 2 cases. In the other ten patients, both RP and RG region were obstructed. The main anatomic causes could also be presumed by analyzing the MR images. Conclusion The study suggested that the pathogenesis of OSAS be related with the upper airway caliber and its A P/lateral ratio, the thickness of posterior and lateral wall, the LPFP in RP region, and the size and length of the palate. Dynamic MRI during sleep could localize the upper airway obstruction in OSAS patients and be helpful to select the management project.

关 键 词：睡眠呼吸暂停 综合征 气道梗阻 磁共振成像 OSAS 

分 类 号：R445.1[医药卫生—影像医学与核医学]