摘要
目的:探讨诱导睡眠后上气道阻塞部位的CT定位对阻塞性睡眠呼吸暂停(OSA)患者病情及其手术疗效的评估价值。方法:对40例经多导睡眠监测确诊的中重度OSA患者先行清醒状态下上气道CT扫描;然后对患者经静脉缓慢注射右美托咪定诱导睡眠,待患者在睡眠状态下呼吸暂停时,行上气道相应部位CT扫描;比较并测量两种状态下上气道狭窄水平的截面积,评估诱导睡眠后狭窄水平截面积与患者AHI、血氧饱和度<90%的时间比例(CT90)的相关性。根据诱导睡眠后各解剖分区的狭窄程度将40例OSA患者分为实验1组(22例)和实验2组(18例),实验1组行低温等离子辅助改良悬雍垂腭咽成形术,实验2组行多平面联合手术;术后随访12个月,比较两组疗效、手术前后各狭窄平面截面积值的变化,以及睡眠质量相关指标的变化。结果:与清醒呼吸状态下上气道CT所测鼻咽区、软腭后区、舌根后区及会厌后区的截面积测量值比较,睡眠状态下各阻塞平面的截面积减小,差异有统计学意义(P<0.01)。上气道各平面睡眠相最小截面积与AHI及CT90呈统计学意义负相关,其中软腭后区和舌根后区与AHI、CT90相关性较高。治疗后12个月实验1组睡眠相各区最小截面积与治疗前比较,软腭后区改善明显(P<0.01),其次是舌根后区(P<0.05),鼻咽区与会厌后区比较差异无统计学意义;实验2组与治疗前比较,鼻咽区、软腭后区、舌根后区、会厌后区差异均有统计学意义(P<0.01或P<0.05)。两组睡眠相关指标ESS、CT90、AHI、LSaO2在治疗后12个月优于治疗前,差异有统计学意义(P<0.01)。实验1组与实验2组有效率分别为72.72%和95.23%(χ^(2)=10.62,P<0.01),显效率分别为58.33%和80.45%(χ^(2)=8.62,P<0.01),治愈率分别为12.37%和17.48%(χ^(2)=7.62,P<0.01)。结论:药物诱导睡眠后对OSA患者进行CT检查安全可行,其对上气道阻塞部位的准确定位具有重要价值;诱导睡眠下64排�
Objective: To explore the value of CT location of the upper airway obstruction site after inducing sleep on the condition of obstructive sleep apnea(OSA) and its surgical efficacy. Methods: Forty patients with moderate-to-severe OSA diagnosed by polysomnography, first performed awake CT scan, then, the patient was slowly injected intravenously with dexmedetomidine to induce sleep, when the patient was apnea during sleep, CT scan of the corresponding part of the upper airway was performed. Compare and measure the cross-sectional area of the upper airway stenosis level in the two states, and evaluate the correlation between the cross-sectional area of the stenosis level after induction of sleep and the patient’s AHI, blood oxygen saturation<90% of the time(CT90). According to the change value of the cross-sectional area of each plane, it was divided into 2 groups, 22 cases in first group underwent hypothermia plasma uvulapalatopharyngoplasty, and 18 cases in second group underwent multi-plane combined surgery. After 12 months of follow-up, compare the post-long-term efficacy, changes in cross-sectional area values of various narrow planes before and after surgery, and changes in indicators related to sleep quality between the two groups. Results: Compared with the cross-sectional area of the nasopharyngeal area, posterior soft palate area, the posterior tongue area, and the epiglottis area measured by upper airway CT under awake breathing state, the cross-sectional area of each obstruction plane during sleep state decreased(P<0.01). The minimum cross-sectional area of the upper airway plane sleep phase was negatively correlated with AHI and CT90, and the posterior soft palate and the posterior lingual base were highly correlated with AHI and CT90.12 months after treatment, the minimum cross-sectional area of each phase of the sleep phase in the experimental group 1 was significantly improved(P<0.01) compared with that before treatment, followed by the posterior tongue area(P<0.05). There was no statistical differ
作者
谭健
陈伟
胡姚
崔前波
李程
曾珊
蔡毅
袁琨
TAN Jian;CHEN Wei;HU Yao;CUI Qianbo;LI Cheng;ZENG Shan;CAI Yi;YUAN Kun(Department of Otolaryngology,the Central Hospital of Wuhan,Tongji Medical College,Hua-zhong University of Science and Technology,Wuhan,430014,China)
出处
《临床耳鼻咽喉头颈外科杂志》
CSCD
北大核心
2021年第8期683-688,共6页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
基金
武汉市卫健委基金项目(No:WX13B08)。
