4种状态下OSAHS患者上气道软组织狭窄程度的镜下比较  

Comparison of the degree of upper airway soft tissue stenosis in four status of OSAHS patients

作　　者：朱梅[1] Zhu Mei(Department of Otorhinolaryngology,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,100050

出　　处：《北京医学》2018年第7期679-682,F0003,共5页Beijing Medical Journal

基　　金："扬帆"计划-临床技术创新项目(12016B4016)

摘　　要：目的比较阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者在不同状态下上气道软组织狭窄部位、形态及程度。方法随机抽取48例经多导睡眠监测(polysomnograpy,PSG)确诊的中重度OSAHS患者,分别行清醒坐位、清醒平卧位、清醒侧卧位及药物诱导睡眠平卧位4种状态下上气道软组织塌陷部位、形态及程度的自身比较,并根据VOTE(velum,oropharynx,tonguebase,epiglottis)评分方法对腭咽平面、口咽侧壁平面、舌根平面及会厌平面狭窄度进行评分。结果清醒坐位、清醒平卧位、清醒侧卧位及药物诱导睡眠平卧位4种状态下,腭咽平面、口咽侧壁平面、舌根平面及会厌平面4个平面阻塞部位及程度差异均有统计学意义(P<0.05);清醒坐位各个平面阻塞最轻,睡眠平卧位最重,尤其舌根及会厌平面差异较大,口咽侧壁平面变化较小。睡眠平卧位,清醒平卧位的VOTE总评分值与呼吸暂停低通气指数(apnea-hypopnea index,AHI)呈正相关(P<0.05)。结论药物诱导睡眠喉镜(drug-induced sleep endoscopy,DISE)对OSAHS患者上气道软组织狭窄部位及程度的判断对于OSASH患者腭咽平面尤其舌咽平面的软组织阻塞定位有一定帮助。Objective To observe the accuracy of location, morphology and degree of upper airway soft tissue stenosis in patients with obstructive sleep apnea hypopnea syndrome（OSAHS）, in order to guide operative selection and prognostic evaluation. Methods Forty-eight patients with moderate and severe OSAHS diagnosed by polysomnograpy（PSG） were randomly selected in this study. Drug-induced sleep endoscopy（DISE） examination was used to locate the obstruction plan among Obstructive Sleep Apnea（OSA） patients. They were checked in 4 status： sober sitting position, sober supine position, sober lateral position and sleeping supine position induced by drug, respectively. The degree of upper airway soft tissue stenosis was evaluated according to VOTE（velum, oropharynx, tonguebase, epiglottis） score method of palatopharyngeal plane, pharynx lateral wall of oropharynx, tongue and epiglottis plane. Results In 4 status, upper airway stenosis in sleeping supine position induced by drug was the heaviest. The difference among them was statistically significant（P0.05）, in which P = 0.000 in palatopharyngeal plane, tongue and epiglottis plane, P = 0.009 in pharynx lateral wall of oropharynx, plane. The total score in sober supine position（P = 0.022） and sleeping supine position induced by drug（P = 0.000） were positively correlated with AHI values（P0.05）. The result of DISE was the closest to the pathophysiological state. Conclusion The DISE results are more severe than those of the other three status in patients with OSAHS.

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 Muller试验 药物诱导睡眠喉镜 VOTE评分 

分 类 号：R766[医药卫生—耳鼻咽喉科]