鼻咽3 D－CT检查对 OSAHS患者术前评估的临床意义

摘要

Objective To study the clinical significance of nasopharynx 3D-CT in preoperative evaluation of obstructive sleep apnea hypopnea syndrome ( OSAHS) patients.Methods 82 patients with OSAHS were randomly selected in our hos-pital, and 60 non-OSAHS patients treated in the same period were selected as the control group.All patients received 3D-CT examination before operation,and OSAHS patients were treated with PSG.By measuring the hard palate and the posterior pharyngeal wall edge distance ( L1 ) , nasal cavity diameter in hard palate horizontal ( L2 ) ,extent from free edge of uvula to postpharyngeal ( L3 ) ,the depth of soft palate ( L4 ) ,the depth of uvula ( L5 ) ,in the level of epiglottis tip the tongue and the posterior pharyngeal wall distance (L6),the epiglottis tip and the posterior pharyngeal wall distance (L7),in the middle level of the hyoid bone hyoid and the posterior pharyngeal wall distance ( L8 ) and the shortest distance of the Phar-ynx ( L9 ) ,we investigated the characteristics of pharyngeal cavity.3D-CT inspection data were compared and used in cor-relation hypothesis test and association evaluation between measuring mean and effect.Results The preoperative PSG re-vealed AHI(42.75 ±23.22)frequency per hour and OAI(20.29 ±18.60)frequency per hour.The mean values of preoper-ative measurement by nasopharynx 3D-CT were L1(20.39 ±4.34)mm,L2(18.57 ±2.55)mm,L3(5.49 ±2.87)mm,L4 (6.52 ±2.68)mm,L5(2.85 ±1.86) mm,L6(12.87 ±6.84)mm,L7(8.76 ±5.06)mm, L8(31.52 ±7.57)mm, and L9 (12.02 ±6.71) mm.Compared to the control group,the differences of 3D-CT index were statistically significant ( P<0.05).By using the correlation hypothesis test and evaluating the association between nasopharynx 3D-CT and PSG,L4 and L5 had the positive correlation,L1 ,L2 ,L3 ,L6 and L9 had the negative correlation.Conclusions We use the nasopharynx 3D-CT, which has three-dimensional space measurement techniques, to evaluate the characteristics of pharyngeal cavi-ty.Its application in preoperative evaluation has significantly guided treatment options.%目的：研究鼻咽3D－CT检查对阻塞性睡眠呼吸暂停低通气综合征（ OSAHS）患者术前评估的临床意义。方法选择中国医科大学附属第一医院耳鼻咽喉科收治的OSAHS患者82例作为OSAHS组；另选择同期收治的非OSAHS患者60例为对照组，两组术前均行鼻咽3D－CT检查，且对OSAHS患者行多导睡眠监测（ PSG）。通过鼻咽3D－CT立体空间测量硬腭后缘与咽后壁距离（ L1）、硬腭水平与鼻咽腔横径（ L2）、悬雍垂后缘与咽后壁距离（L3）、软腭厚度（L4）、悬雍垂厚度（L5）、会厌尖水平舌根与咽后壁距离（L6）、会厌尖与咽后壁距离（L7）、舌骨水平舌骨正中与咽后壁距离（ L8）及硬腭至舌骨水平咽腔最短横径（ L9）。比较分析鼻咽3D－CT检查数据，应用相关性检验评估鼻咽3D－CT各测量值与PSG监测的呼吸暂停低通气指数（ AHI）及阻塞性呼吸暂停指数（ OAI）的关系。结果 OSAHS组术前AHI为（42．75±23．22）次／h，OAI为（20．29±18．60）次／h；术前OSAHS组鼻咽3D－CT测量平均值依次L1为（20．39±4．34）mm，L2为（18．57±2．55）mm，L3为（5．49±2．87）mm，L4为（6．52±2．68） mm，L5为（2．85±1．86） mm，L6为（12．87±6．84） mm，L7为（8．76±5．06） mm，L8为（31．52±7．57） mm，L9为（12．02±6．71） mm，与对照组患者比较各指标差异均有显著性意义（ P＜0．05）。鼻咽3D－CT及PSG两种检查指标的相关性检验分析显示，L4和L5分别与AHI及OAI呈正相关，L1、L2、L3、L6和L9分别与AHI及OAI呈负相关。结论鼻咽3D－CT通过其立体空间测量技术了解OSAHS患者的咽峡结构特点，为不同OSAHS患者术前评估制定个性化手术方案提供重要的客观临床指导。