摘要
目的完全肌松条件下评估阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者软腭后气道的塌陷特性（被动塌陷性），评价解剖结构因素异常在OSAHS发病机制中的作用。方法OSAHS患者30例，无鼾对照者14例，全麻完全肌松后次序给予软腭后气道3～20cm H2O（1cm H2O=0．09806 kPa）的正压，纤维喉镜定标记录各压力值时咽腔面积。测压并分析能使软腭后咽腔刚刚开放所需的腔内压，即软腭后临界开放压，代表该气道段被动塌陷性。结果30例OSAHS患者完全肌松后气道硬腭平面完全塌陷的1例（3．3％），无鼾对照组14例均无塌陷；全部患者软腭悬雍垂平面完全塌陷，即临界开放压力均大于大气压，对照组有5例仍维持开放（35．7％）；舌咽平面全部塌陷的患者共23例（76．7％），对照组7例（50．0％）。OSAHS患者软腭后区平均临界开放压力中位数8．3[5．9；11．5]cm H2O[25分位数；75分位数]，与对照组2．7[-3．9；6．0]cm H2O比较差异有统计学意义（U=58．500，P=0．000）。相关分析发现临界开放压力与AHI呈正相关（r=0．377，P=0．04）。结论OSAHS患者气道被动塌陷性异常增加，咽腔的开放必须依赖咽壁扩张肌主动作用，以软腭后区和舌后区为主。不同OSAHS个体肌松状态下软腭后区临界开放压力及咽壁顺应性存在差异。
Objective To evaluate the mechanical load of retropalatal airway in obstruetive sleep apnea patients, and to investigate the contributions of pharyngeal anatomy to upper airway collapsibility. Methods Static mechanical load of transpalatal pharynx was determined by opening pressure （Popen） of the segment during general anesthesia in 30 patients and 14 controls. Size of pharynx was measured while intraluminal pressure was controlled at 3 -20 cm H2O（ 1 cm H2O = 0.09806 kPa） and the minimal intraluminal pressure that needed to compensate for the mechanical load of a retropalatal segment was determined. Results Pharyngeal cavity collapse at the level of the hard palate was observed in only one of the 30 subjects （3.3%）, and in none of the 14 controls. At tongue base level, 23 subjects had a Popen 〉0cm H2O （76. 7% ） while in 7 of the controls （50. 0% ） had a Popen 〉0cm H2O. And at the level of the uvual and soft palate, pharyngeal collapses was observed in all subjects except in 9 of the controls （64. 3% ）. The median of Popen was 8.3[5.9;11.5] cm H2O in the patients group and was 2. 7[ -3.9; 6. 0 ] cm H2O in the control group. Differences of Popen were signifcant between patients and controls （U = 58. 500, P = 0. 000）. The correlation between Popen and AHI was also significant at 0.05 level （r = 0. 377, P = 0. 044 ）. Conclusions Patients with sleep apnea have more collapsible passive upper airway than controls. Retropalatal and retroglossal airway are the most collapsible segments and positive pressures are needed to compensate for the mechanical loads.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2009年第10期819-824,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
国家自然科学基金（30672304）
关键词
睡眠呼吸暂停
阻塞性
咽肌
肌松弛
压力
Sleep apnea, obstructive
Pharyngeal muscles
Muscle relaxation
Pressure
