摘要
目的 应用计算机辅助纤维喉镜检查结合M櫣ｌｌｅｒ检查法 (computerassistingfiberopticpharyngoscopywithm櫣ｌｌｅｒ′ｓｍａｎｅｕｖｅｒ,CFPMM)研究阻塞性睡眠呼吸暂停综合征 (obstructivesleepapneasyndrome ,OSAS)上气道形态异常 ,探讨该方法在OSAS定位诊断中的应用价值。方法 CFPMM观察OSAS患者及无鼾症症状及相关疾病对照组各 30例腭咽、舌咽最小截面积 ,矢状径与横向径比值 ,咽壁顺应性 ,判定上气道阻塞位点 ,形成阻塞的解剖因素 ,并与多导睡眠图分析 (polysomnography,PSG)进行相关研究。结果 ①CFPMM可实现上气道各部截面积的直接测量及顺应性的定量判定 ;②OSAS腭咽、舌咽最小截面积明显小于对照组 ,气道顺应性比较也存在显著差异 ;③OSAS组M櫣ｌｌｅｒ检查时气道最小截面积均小于 40mm2 ;6 0 % (18/ 30 )出现气道完全闭塞 ;④OSAS组全部存在腭咽平面阻塞 ,其中合并舌咽平面阻塞率为 40 % (12 / 30 ) ;⑤腭咽阻塞的主要因素为软腭过长 ,咽侧壁肥厚及顺应性增大 ;舌咽阻塞原因除舌根淋巴组织增生、舌根后坠外 ,双侧扁桃体下极肥大及喉咽侧壁顺应性增大 ,占较重要地位 ;⑥气道最小截面积、顺应性与OSAS严重程度存在明显相关性。结论 ①应用CFPMM可定量观察OSAS气道截面积及顺应性 。
Objective To investigate the upper airway (UA) characteristics of the patient′s with obstructive sleep apnea syndrome (OSAS) and analyses the value of computer assisting fiberoptic pharyngoscopy with müller′s maneuver (CFPMM) in topodiagnosis of OSAS Methods The pharyngxes of 30 cases with OSAS and 30 controls were examined by CFPMM The cross-section area at velo- and tongue-pharyngeal, pharyngeal collapsibility, sites of UA obstructive and their anatomical factors were measured and calculated and the correlation between the anatomical abnormalities of UA and outcomes of polysomnography (PSG)were analysed Results ①CFPMM can accurately measure and calculate the cross-section area of the upper airway ②mean areas of velopharyngeal and tongue-pharyngeal were significantly less than those in control subjects (all P <0 05) OSAS patient′s also showed relatively much larger collapsibility at sach site of the UA than controls ③At müller′s maneuver, all the areas of OSAS patient′s were below 40 mm 2 and 60% cases appeared complete occlusion in pharyngeal ④All patient′s had obstruction at velopharymx and airway collapses at multiple sites in 40% of cases ⑤At velopharyngeal the anatomical factors causing obstruction mainly were posterior displacement of soft palate, thicken and collapse of the pharyngeal wall Besides the redundant lymph tissue at tongue base and posterior displacement of the tongue base, enlarged inferior pole of tonsil and collapse of pharyngeal wall played an important role at tongue-pharyngeal obstruction ⑥ Diminished pharyngeal apertures and collapsibility were associated with increased rates of apnea and hypopnea index ( P <0 05) Conclusions ①CFPMM is able to measure and calculate UA′s cross-section area and collapsibility, determine the site of obstruction, and helping the treatment ②Complete occlusion of UA at müller′s maneuver is the criterion to determine site of UA obstruction in OSAS patient′s during waking hours ③ The anatomical abnormalities of UA of patients is reflects the severity of the OSAS
出处
《中华耳鼻咽喉科杂志》
CSCD
2000年第4期278-281,I021,共4页
Chinese Journal of Otorhinolaryngology
关键词
阻塞性睡眠呼吸暂停综合征
上气道
CFPMM
Sleep apnea syndromes
Decision making
computer-assisted
Polysomnography
Fiberoptic pharyngoscopy
müller's maneuver
