鼻通气功能评估在睡眠呼吸紊乱疾病中的应用价值  

The application of nasal ventilation function on sleep-disordered breathing disorders

作　　者：严小玲[1] 徐亚丽[1] 李敏雄[1] 黄敏齐[1] 廖礼兵[1] 王晓利[1] 黄映红[1] 张建国[1] 

机构地区：[1]广州医科大学附属第二医院耳鼻咽喉科,广州510260

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第15期1112-1117,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的：探讨睡眠呼吸紊乱（SDB）人群中鼻腔通气功能的改变及鼻通气功能的各项指标与PSG监测指标的相关性。方法：利用NV1鼻呼吸量仪测量128例正常人、11例习惯性打鼾患者和33例轻中度OSAHS和33例重度OSAHS的单侧鼻腔总呼吸量（NCun）、双侧鼻腔总呼吸量（NCbi）和鼻呼吸流量差异比（NPR,包括吸气量差异比NPRi和呼气量差异比NPRe）;利用NR6鼻阻力仪测量受试者的双侧鼻腔吸气相的总阻力（TNRi）和双侧鼻腔呼气相的总阻力（TNRe）;利用A1鼻声反射仪测量受试者的第一切迹距离前鼻孔的距离（MD1）及横截面积（MCA1）、第二切迹距离前鼻孔的距离（MD2）与横截面积（MCA2）及鼻腔0~5cm段的容积（NV0-5）。将鼻通气功能的各项指标与PSG结果进行相关研究。结果：①鼻呼吸量参考值NPR的组间差异有统计学意义（P〈0.01）,而NCbi及NCun无组间差异。②TNRi和TNRe的组间差异均有统计学意义（P〈0.01或P〈0.05）,其中正常对照组与轻中度OSAHS组的TNRi差异有统计学意义（P〈0.01）;对照组与重度OSAHS组的TNRi和TNRe均差异有统计学意义（均P〈0.01）。③男性患者的MD1、MCA1、MCA2、NV0-5参数有显著的组间差异（均P〈0.05）;但在女性患者中,MCA1、MD2、MCA2和NV0-5均无组间差异。④在SDB人群中,PSG各指标与鼻通气功能指标均无相关性。将BMI进行分级（〈25;25~35;〉35）,发现BMI〈25的女性患者中最低血氧饱和度与MCA2呈正相关（r=0.688,P〈0.05）,微觉醒指数与MCA1呈负相关（r=-0.543,P〈0.05）;而男性人群中各指标仍无相关性。结论：鼻腔解剖结构和生理功能的改变与SDB发病有关,而鼻腔阻塞对SDB疾病的作用在非肥胖女性患者中较肥胖患者更为显著。Objective：To explore the change of nasal ventilation function in a group of SDB patients and its relationship to PSG parameters.Method：One hundred twenty-eight controls,11habitual snorers,33cases of mild-moderate OSAHS and 33cases of severe OSAHS were examined.NN1Rhinospirometer was used to measure unilateral nasal respiratory capacity（NCun）and bilateral nasal respiratory capacity（NCbi）,and the nasal partitioning ratio（NPR）can be calculated.NR6Rhinomanometry was used to measure total nasal inspiratory and expiratory resistance（TNRi,TNRe）.A1acoustic rhinometry was used to measure distances of the two notches to the nostril（MD1,MD2）,cross-sectional areas of the two notches（MCA1,MCA2）and nasal volume from 0-5cm（NV0-5）.Moreover,make the correlational analysis on different index of nasal functional tests and PSG.Result：①Significant group differences were shown in NPR（P＆lt;0.01）.②TNRi and TNRe were statistical different among the groups（P＆lt;0.01or P＆lt;0.05）.③There are significant difference on MD1,MCA1,MCA2,NV0-5in male,but just on MD1in female.④There was no correlation between PSG parameters and nasal functional parameters in SDB patients.But for certain subgroup analysis in female patients with a body mass index below 25,minimum oxygen saturation correlated significantly with MCA2（r=0.688,P＆lt;0.05）,arousal index correlated significantly with MCA1（r=-0.543,P＆lt;0.05）.Conclusion：The nasal anatomical structure and physiological function contribute to the pathogenesis of OSAHS,which may play a larger role in non-obese female patients.

关 键 词：睡眠呼吸紊乱 鼻呼吸量 鼻阻力 鼻声反射 多导睡眠监测 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]