药物诱导睡眠喉镜检查与Müller检查在阻塞性睡眠呼吸暂停综合征中的临床应用  

Clinical application of drug-induced sleep endoscopy and Müller's maneuver in obstructive sleep apnea syndrome

作　　者：白雪[1] 朱梅[1] BAI Xue;ZHU Mei(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China.)

机构地区：[1]首都医科大学附属北京友谊医院耳鼻咽喉头颈外科,北京100050

出　　处：《临床和实验医学杂志》2018年第18期1997-2001,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市医院管理局2017年扬帆计划临床技术创新项目(编号:12016B4016)

摘　　要：目的比较药物诱导睡眠喉镜(DISE)检查与Müller实验在阻塞性睡眠呼吸暂停综合征患者中,哪种方法能更加精准的定位,哪种方法能更加准确的描述上气道塌陷情况。通过睡眠喉镜检查观察患者鼾声来源,解决鼾症患者的问题。方法回顾性选取98例患者作为研究对象,经PSG检查诊断为阻塞性睡眠呼吸暂停综合征。入院后均行DISE检查和Müller试验,检查结果分两部分记录,堵塞位置和堵塞程度,对比两种方法在各种狭窄中检查结果的一致性,并且记录鼾声来源。结果两种方法检查结果的一致性具有统计学意义,软腭平面前后径狭窄有62.7%一致性,左右径狭窄有75.0%一致性,环形狭窄有81.8%一致性,口咽平面左右径狭窄78.5%一致性。舌根前后径狭窄有26.7%一致性,会厌平面左右径狭窄有25%一致性,在前后径狭窄有31.5%一致性,而喉部环形狭窄的一致性仅有19.2%。3例患者在DISE检查中出现声带扑动。鼾声来源于软腭平面占74.5%,来源于咽侧壁占30.6%,来源于舌根/会厌平面占28.6%,来源于声门占3.1%。结论 DISE具有安全性、操作简单、可靠性高的优势,比Müller试验更能客观地反映出阻塞性睡眠呼吸暂停综合征患者上气道阻塞的程度及形式,并且能直观的观察到鼾声来源,对于鼾症患者解决鼾声治疗提供有力的临床依据。Müller试验在评估软腭、口咽平面也可以提供充分的临床依据。Objective Comparison of drug-induced sleep endoscopy（DISE） and Müller＇s maneuver（MM） in patients with obstructive sleep apnea syndrome（OSAS） to determine which method can more successful at identifying the site of obstruction and the pattern of upper airway collapse. Through observing the source of snoring to solve the problem of patients with sleep apnea. Methods 98 patients（76 male and 22 female） with OSAS at our clinic were selected in this study. Ages ranged from 26 to 62 years old and the average age was 47. 5 years. All patients underwent DISE and MM and the results of these examinations were characterized according to the region/degree of obstruction,to compare the consistency of the results of the two methods in various stenosis,also to record snoring source. The results of each test were analyzed per upper airway level and compared using statistical analysis（Kappa statistic test）. The difference was statistically significant（P〈0. 05）. Results There was statistically significant concordance between the results from DISE and MM for procedures involving the anteroposterior（62. 7%）,lateral（75. 0%）,and concentric（81. 8%） configuration of the velum. Results from the lateral part of the oropharynx were also in concordance between the tests（78. 5%）. Results from the lateral configuration of the epiglottis were in concordance between the tests（25. 0%）. There was no statistically significant concordance between the two examinations for procedures involving the anteroposterior of the tongue（26. 7%） and epiglottis（31. 5%）.There was no statistically significant concordance between the two examinations for concentric of the throat（19. 2%）. Three patients in the DISE record vocal cords flapping. Snoring was derived from the soft palate plane accounted for 74. 5%,pharyngeal wall accounted for 30. 6%,tongue/epiglottis plane accounted for 28. 6%,glottis accounted for 3. 1%. Conclusion DISE has the advantages of safety,simple operation,high reliability,which is b

关 键 词：阻塞性睡眠呼吸暂停综合征 药物诱导睡眠喉镜检查 Müller检查 鼾声 

分 类 号：R766[医药卫生—耳鼻咽喉科]