阻塞性睡眠呼吸暂停低通气综合征患者上气道实时CT研究

摘要

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者清醒及药物诱导睡眠状态下实时CT扫描方法,评价其临床应用价值.方法 对62例经多道睡眠监测确诊的OSAHS患者行清醒及药物诱导睡眠呼吸暂停发作状态下上气道256层螺旋CT扫描,所获图像数据进行处理(多平面重建及容积测量、咽腔最小截面积值、相应径线及咽腔容积测量).比较同一患者清醒和睡眠状态下上气道大小的动态变化,通过咽腔各参数的测量反映上气道阻塞情况,并定位阻塞部位.结果 本组62例患者均顺利完成实时CT检查,软腭后区及舌后区气道为常见阻塞区域.单一软腭后区阻塞或狭窄者29例,软腭后区+舌后区阻塞或狭窄者19例,软腭后区+会厌后区阻塞或狭窄者6例,软腭后区+舌后区+会厌后区阻塞或狭窄者7例,软腭后区+舌后区+会厌后区均未见阻塞或狭窄1例.本研究中未发现单一舌后区及会厌后区阻塞或狭窄者.单一区域阻塞或狭窄者占46.8％(29/62),多区域阻塞或狭窄者占51.6％(32/62).根据Friedman腭舌关系分型,I～Ⅳ型舌后区和(或)会厌后区气道阻塞或狭窄的发生率逐渐增高,四组间差异有统计学意义(x2=22.00,P＜0.005).对比清醒状态和睡眠呼吸暂停发作状态下各解剖区域(软腭后区、舌后区及会厌后区)最小截面积、气道容积、最小前后径及左右径等参数,差异均有统计学意义(P值均＜ 0.05).结论 应用药物诱导睡眠下的实时CT技术可获得上气道阻塞或狭窄的解剖和病理变化的活体信息,为OSAHS的定位诊断与个体化治疗提供相对客观的形态学依据,具有重要的应用价值.%Objective To explore the technology and clinical application of real-time CT scan in obstructive sleep apnea hypopnea syndrome during awake and drug induced sleep state.Methods Sixty-two patients with OSAHS diagnosed by polysomnography underwent 256 layer spiral CT scan during awake and drug-induced sleep apnea state,and multiplanar reconstruction and volume rendering of computed tomography images were performed.To observe the dynamic changes of upper airway and locate the sites of airway obstruction in patients with OSAHS,the minimum section area,diameter and volume of pharynx cavity were measured on reconstructed 3-dimensional computed tomography.Results Real-time CT scans were completed successfully in all of the patients.It was revealed that airway obstruction frequently occurred at retropalatal and retroglottal region.Real-time CT scans revealed 29 cases with airway obstruction at isolated retropalatal region,19 cases with airway obstruction at retropalatal and retroglottal region simultaneously,6 cases with airway obstruction at retropalatal and epiglottal region simultaneously,7 cases with airway obstruction at retropalatal,retroglottal and retroglottal region simultaneously,I case without airway obstruction.There was no airway obstruction at retroglottal or retroglottal region isolatedly.Rate of single region airway obstruction was 46.8 ％ (29/62),and rate of multiple regions airway obstruction 51.6％(32/62).The real-time CT results showed that starting from Friedman tongue position I to Ⅳ,the percentage of obstruction at retroglottal and (or) retroglottal region simultaneously were increasing,the percentage of obstruction were 0/6,8/25,13/20,11/11,respectively (x2 =22.00,P ＜ 0.005).The minimum section area,volume,minimum anteroposterior diameter and left-right diameter of pharynx cavity between awake and drug-induced sleep apnea state had statistically significant difference in all region.Conclusions Real-time CT scans in drug-induced sleep state could get more information about the anatomical and pathological changes of upper airway,providing relatively objective morphological basis for the diagnosis and treatment of patients with OSAHS.Therefore,real-time CT scans have important value in practical application.