阻塞性睡眠呼吸暂停患者阻塞平面多种评估方式间相关性分析  

Analysis of correlation among multiple assessment methods forobstructive levels in patients with obstructive sleep apnea hypopnea syndrome

作　　者：聂帅 文连姬[1] 于丹[1] 郭海仙[1] 刘悦[1] 李绍楠 谷婷婷 于任游[1] 刘岩[1] NIE Shuai;WEN Lianji;YU Dan;GUO Haixian;LIU Yue;LI Shaonan;GU Tingting;YU Renyou;LIU Yan(Department of Otolaryngology Head and Neck Surgery,the Second Hospital of Jili University,Changchun,Jilin,130022,China)

机构地区：[1]吉林大学第二医院耳鼻咽喉头颈外科,吉林长春130022

出　　处：《中国耳鼻咽喉头颈外科》2020年第12期701-704,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：吉林省财政厅项目(2020SCZT049)。

摘　　要：目的研究探讨阻塞性睡眠呼吸暂停患者阻塞平面的多种评估方式间的相关性。方法 2019年10月16日~2020年10月20日就诊于吉林大学第二医院耳鼻咽喉头颈外科经便携式睡眠监测仪确诊为阻塞性睡眠呼吸暂停的27例拟手术患者。所有患者术前常规行电子纤维鼻咽喉镜下Müller’s检查(Müller’s maneuver,MM)、Friedman临床分型(Friedman score,Fs)、药物诱导睡眠内镜(drug-induced sleep endoscopy,DISE)来评估上气道阻塞情况,并进行VOTE评分。结果 MM中软腭和舌根平面阻塞率分别为92.59%和40.74%;DISE下软腭、口咽、舌根、会厌平面阻塞率分别为81.48%、88.89%、40.74%、62.96%。在软腭平面,MM、DISE检查结果具有一致性(55.56%),其中25.93%与Fs也具有一致性,结果有统计学意义(P<0.05);在MM、DISE检查结果不具有一致性的患者中,MM与Fs、DISE与Fs一致的分别占22.22%,18.52%;三者均不一致的占3.70%。结论 27例患者中,55.56% MM和DISE评估软腭平面阻塞具有一致性,但与Fs无明显一致性。因此,MM与DISE可作为指导评估阻塞平面的方式,Fs则可作为一种辅助方式参与评估。另外,与MM相比,DISE可发现更多平面阻塞,尤其是舌根或会厌平面的阻塞。临床上建议联合使用多种方式进行阻塞平面的评估。OBJECTIVE To investigate the correlation among multiple assessment methods for obstructive levels in patients with obstructive sleep apnea hypopnea syndrome(OSAHS).METHODS A total of 27 patients with OSAHS confirmed by portable polysomography were admitted to Department of Otolaryngology Head and Neck Surgeryof the Second Hospital of Jilin University since Oct.16,2019 to Oct.20,2020.All patients underwent preoperative routine examinations,such as fiberotic laryngoscopy for Müller’s maneuver(MM),Friedman score(Fs) and drug-induced sleep endoscopy(DISE) to assess the upper airway obstruction and get a VOTE score.RESULTS The occurrence of obstruction in the level of soft palate andtongue base was 92.59% and 40.74% respectively under MM.For DISE examination,the occurrence of obstruction in the level of velum,oropharyngeal lateral wall,tongue base and epiglottis were 81.48%,88.89%,40.74%,62.96% respectively.In the soft palate level,the results were consistent between MM and DISE(55.56%),including 25.93% subjects consistent with Fs(P<0.05).Among the subjects that did not show consistency of MM and DISE,Fs showed consistency with MM in 22.22% of the patients,and with DISE in 18.52% of the patients.And 3.70% of the subjects showed no consistency among MM,DISE and Fs.CONCLUSIONIn 55.56% of the patients,MM and DISE were consistent in the evaluation of soft palate level obstruction,but not significantly consistent with Fs.Therefore,MM and DISE can be used to evaluate the obstruction level,and Fs can be used as an auxiliary way to participate in the evaluation of obstruction level.In addition,compared with MM,DISE can find more planar obstruction,especially in the tongue base or epiglottic level.Clinically,it is recommended to use a variety of methods to evaluate the obstruction levels.

关 键 词：睡眠呼吸暂停 阻塞性 Müller’s检查 Friedman临床分型 药物诱导睡眠内镜 

分 类 号：R766[医药卫生—耳鼻咽喉科]