脑卒中后OSA与吞咽障碍之间关系的临床研究分析

发布时间：2018-08-01 09:17

【摘要】：目的：通过观察脑卒中后阻塞性睡眠呼吸暂停(obstructive sleep apnea OSA)与吞咽障碍患者口咽部形态学变化特点,阐明脑卒中后OSA发生的机制,明确卒中后OSA、患者口咽部形态学改变及吞咽困难三者之间的相互关系,为探索脑卒中后OSA的康复治疗方法提供理论依据。方法：选取50例符合入选条件的脑卒中发病早期患者,所有患者均接受整晚多导睡眠图(polysomnography PSG)监测并采集相应参数,其中41例患者接受3.0T磁共振仪进行口咽部MRI平扫并测量相关指标；所有患者进行常规评估及吞咽功能评估(洼田饮水试验及Gugging Swallowing Screen即GUSS评分),其中23例接受纤维内视镜检查(fiberoptic endoscopic evaluation of swollowing FEES)。结果：(1)脑卒中合并OSA与不合并者相比,洼田饮水试验得到的吞咽障碍的严重程度更高,GUSS评分更低,具有统计学差异(P值0.01)；(2)脑卒中经FEES确诊吞咽障碍的患者PSG监测指标AHI、OAI、HI、ODI数值较不合并吞咽障碍者更大,平均血氧饱和度与不合并吞咽障碍者相比更低,两者比较有统计学意义(P=0.001/0.003/0.001)； (3)有吞咽障碍的患者并发OSA的百分比为95.6%；无吞咽障碍的患者共27例,其中16例并发OSA,无吞咽障碍的患者并发OSA的百分比为59.2%；经卡方检验P值为0.003,结果显示,有吞咽障碍的卒中患者并发OSA的比率比没有吞咽障碍的更高,两者比较有统计学意义(P=0.003); (4) GUSS评分与AHI值(R=-0.382,P=0.006)、OAI值(R=-0.320,P=0.024)、ODI值(R=-0.440,P=0.001)、低通气(R=-0.279,P=0.050)均呈负相关； (5)洼田饮水情况与AHI值(R=-0.326,P=0.021)、ODI值(R=-0.396,P=0.004)呈正相关；合并吞咽障碍的脑卒中患者腭后距离、舌后距离、舌后最短距离及咽部最窄面积较不合并者偏小,两者相比有统计学意义(P=0.007/0.001/0.026/0.033)；(6)腭后距离与洼田饮水评估(R=-0.513,P=0.015)呈负相关；舌后最短距离与洼田饮水评估(R=0.729,P=0.001)呈负相关；(7)腭后距离与AHI值(R=-0.717,P=0.000)、OAI值(R=-0.656,P=0.001)、ODI值(R=-0.749,P=0.000)及低通气(R=-0.707,P=0.000)均呈负相关；舌后距离与AHI值(R=-0.800,P=0.000)、OAI值(R=-0.780,P=0.000)、ODI值(R=-0.696,P=0.000)及低通气(R=-0.641,P=0.001)均呈负相关；舌后最短距离与AHI值(R=-0.898,P=0.000)、OAI值(R=-0.913,P=0.000)、ODI值(R=-0.917,P=0.000)、平均血氧(R=-0.541,P=0.031)及低通气(R=-0.886,P=0.000)呈负相关；咽部最窄面积与低通气(R=-0.451,P=0.035)呈负相关；(8)将卒中后吞咽障碍、口咽部形态学与PSG监测指标AHI进行协方差分析,结果显示吞咽障碍和腭后距离存在交互作用,对OSA监测指标AHI产生影响。结论：脑卒中后阻塞性睡眠呼吸暂停(OSA)与卒中后吞咽障碍密切相关；OSA与吞咽障碍的发生均与口咽部形态学改变有关,表现为腭后距离、舌后距离变小并与睡眠呼吸暂停指数(AHI)呈相关性。卒中后OSA、吞咽障碍及口咽部形态学改变三者问存在非常紧密的关系,这可能为寻求卒中后OSA的康复治疗提供一定的理论参考价值。
[Abstract]:Objective: by observing the morphological changes of the obstructive sleep apnea OSA after stroke and the oral pharynx of the patients with dysphagia, the mechanism of OSA after stroke was clarified, and the relationship between the three patients after apoplexy OSA, the morphological changes of the mouth pharynx and dysphagia were identified, so as to explore the OSA after stroke. Methods: 50 cases of early cerebral apoplexy were selected and all patients were selected to receive the whole night polysomnography (polysomnography PSG) monitoring and acquisition of the corresponding parameters, of which 41 patients received 3.0T magnetic resonance imaging for MRI plain scan of the mouth pharynx and measured the related indexes; all patients were enrolled. Routine assessment and swallowing function assessment (depression field drinking test and Gugging Swallowing Screen, GUSS score), of which 23 cases received fiberoptic endoscopy (fiberoptic endoscopic evaluation of swollowing FEES). Results: (1) the severity of dysphagia obtained by potable water test in depression was more severe than that of OSA. High GUSS score was lower, with statistical difference (P 0.01); (2) the PSG monitoring index of stroke patients with dysphagia diagnosed by FEES was greater than those without dysphagia, and the average oxygen saturation was lower than those without dysphagia (P=0.001/0.003/0.001); (3) there was swallowing. The percentage of OSA in patients with dysphagia was 95.6%; there were 27 cases without swallowing disorder, of which 16 cases were complicated with OSA, and the percentage of patients with OSA without swallowing disorder was 59.2%; the P value of the chi square test was 0.003. The results showed that the ratio of OSA to dysphagia was higher than that of no dysphagia. Learning significance (P=0.003); (4) GUSS score and AHI value (R=-0.382, P=0.006), OAI value (R=-0.320, P=0.024), ODI value (R=-0.440, P=0.001), low ventilation (R=-0.279,) are all negative correlation; (5) there is a positive correlation between the drinking water situation and the value. The posterior distance, the shortest distance after the tongue and the narrowest area of the pharynx were smaller than those of the unincorporated ones, and there was a statistically significant difference (P=0.007/0.001/0.026/0.033); (6) the posterior distance of the palatine was negatively correlated with R=-0.513 (P=0.015); the shortest distance behind the tongue was negatively correlated with the drinking water assessment (R=0.729, P=0.001) in the depression; (7) the distance between the palatine and the AHI (R=-). 0.717, P=0.000), OAI value (R=-0.656, P=0.001), ODI value (R=-0.749, P=0.000) and low ventilation (R=-0.707, P=0.000) are all negative correlation; the posterior distance of the tongue is negatively correlated with AHI value (R=-0.800, P=0.000), the value and the low ventilation. Values (R=-0.913, P=0.000), ODI (R=-0.917, P=0.000), mean blood oxygen (R=-0.541, P=0.031) and hypoventilation (R=-0.886, P=0.000) were negatively correlated; the narrowest area of the pharynx was negatively correlated with hypoventilation (R=-0.451, P=0.035); (8) a covariance analysis of dysphagia after stroke, oropharynx morphology and PSG monitoring indicators showed swallowing disorder. Conclusion: obstructive sleep apnea (OSA) after stroke is closely related to the dysphagia after stroke, and the occurrence of OSA and dysphagia is related to the morphological changes of the oropharynx, which shows the distance from the palatopharynx, the posterior distance of the tongue and the sleep apnea index (AHI), which is associated with the occurrence of OSA and dysphagia. The relationship between OSA, dysphagia and morphologic changes of the oropharynx after stroke is very closely related, which may provide a certain theoretical reference value for the rehabilitation treatment of OSA after stroke.
【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R743.3;R766

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