下颌前伸止鼾器治疗轻、中度OSAHS患者前后上气道的CBCT研究

发布时间：2018-04-29 11:46

本文选题：阻塞性睡眠呼吸暂停低通气综合征 + 下颌前伸止鼾器　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]观察轻、中度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者戴用下颌前伸止鼾器(MASSD)前后上气道形态及呼吸功能的变化,为明确下颌前伸止鼾器(MASSD)治疗轻、中度OSAHS患者的治疗机制、临床疗效提供参考和依据。[方法]选择2015年2月-2017年1月于昆明医科大学附属延安医院口腔科就诊,经多导睡眠监测确诊为轻、中度OSAHS患者30例,并排除其他可能导致气道阻塞的疾病及解剖异常的患者。其中男性21例,女性9例,年龄25-59岁,平均年龄49岁;对患者戴用MASSD前后的上气道行CBCT扫描,运用InVivo Dental软件重建上气道的三维形态,确定气道的测量平面及分区,测量上气道各截面的矢状径、冠状径、最小横截面积及各段容积,并比较治疗前后患者的呼吸紊乱指数(AHI)及最低血氧饱和度(LSaO2)等指标的改变。数据采用SPSS21.0软件包进行自身配对t检验。[结果]1.30例轻、中度OSAHS患者戴用下颌前伸止鼾器后主观症状明显改善,如无主观憋醒情况,白天嗜睡症状明显改善。陪睡家属观察患者夜间睡眠鼾声大幅减轻甚至消失,呼吸暂停现象明显减轻或消失,患者初戴止鼾器偶有不适,如晨起时个别牙的酸痛、口干等不适,长期戴用无明显不良反应。2.客观指标明显改善:因鼾声次数不服从正态分布,结果以P50 (P25, P75)表示,治疗前后差异用秩和检验,P0.001,差异有显著的统计学意义;未戴MASSD时 AHI 指数(20.61±5.19),戴入 MASSD 后 AHI 指数(10.86±4.31),差异有显著的统计学意义(P0.001);未戴MASSD时最低血氧饱和度(LSaO2)(0.78±0.08),戴入MASSD后最低血氧饱和度(LSaO2) (0.92±0.03),差异有显著的统计学意义(P0.001)。3.轻、中度OSAHS患者的软腭下缘平面未戴MASSD时矢状径(7.01±1.43mm ),戴入MASSD后矢状径(14.78±1.36 mm ),差异有显著的统计学意义(P0.001);软腭下缘平面未戴MASSD时冠状径(20.46±1.24 mm),戴入MASSD后冠状径(28.35±1.85mm),差异有显著的统计学意义(P0.001);会厌下缘平面未戴MASSD 时矢状径(9.58±0.95mm),戴入 MASSD 后矢状径(13.75±0.77mm),差异有显著的统计学意义(P0.001);会厌下缘平面未戴MASSD时冠状径(19.86±2.06mm),戴入MASSD后冠状径(26.72±2.25mm),差异有显著的统计学意义(P0.001);而硬聘平面未戴MASSD时矢状径(12.57±1.30mm),戴入MASSD后矢状径(12.01±1.04mm),差异无统计学意义(P0.05);硬聘平面未戴MASSD时冠状径(27.49±2.92 mm),戴入MASSD后冠状径(29.20±4.17mm),差异无统计学意义(P0.05)。表明患者在戴入MASSD后,软腭下缘平面及会厌上缘平面的矢状径、冠状径明显增大;而硬腭平面无明显变化。4.轻、中度OSAHS患者的软腭后区未戴MASSD时最小横截面积(72.84±20.93 mm2),戴入MASSD后最小横截面积(129.30±26.37mm2),差异有显著的统计学意义(P0.001);舌后区未戴MASSD时最小横截面积(139.54±35.13mm2),戴入MASSD后最小横截面积(188.42±37.08mm2),差异有显著的统计学意义(P0.001);会厌后区未戴MASSD时最小横截面积(112.51±13.69mm2),戴入MASSD后最小横截面积(220.81±22.04mm2),差异有显著的统计学意义(P0.001);总气道未戴MASSD时最小横截面积(72.84±20.93 mm2),戴入MASSD后最小横截面积(129.30±26.37mm2),差异有显著的统计学意义(P0.001)。表明患者气道软腭后区、舌后区、会厌后区的最小横截面积在戴入MASSD后,明显增大,并发现最阻塞的部位于软腭后区。5.轻、中度OSAHS患者的软腭后区未戴MASSD时容积(4.99±0.60cc),戴入MASSD后容积(8.15±0.68cc),差异有显著的统计学意义(P0.001);舌后区未戴MASSD时容积(4.12±0.45cc),戴入MASSD后容积(7.31±0.59cc),差异有显著的统计学意义(P0.001);会厌后区未戴MASSD时容积(2.68±0.23cc),戴入MASSD后容积(3.82±0.52cc),差异有显著的统计学意义(P0.001);气道总体积未戴 MASSD 时容积(11.79±0.87cc),戴入 MASSD 后容积(19.31 ±1.11cc),差异有显著的统计学意义(P0.001)。表明患者在戴入MASSD后,上气道总容积与软聘后区、舌后区、会厌后区各段容积都有增大。[结论]1. MASSD治疗轻、中度OSAHS患者具有较好的临床疗效;2.CBCT muller呼吸坐位扫描,戴用MASSD使轻、中度OSAHS患者上气道的矢状径及冠状径同时增大;3.戴用MASSD使轻、中度OSAHS患者的气道打开,增加上气道通气量,从而改善患者呼吸功能,为OSAHS的临床诊疗工作提供理论指导。
[Abstract]:[Objective] to observe the changes in the upper airway morphology and respiratory function of patients with moderate obstructive sleep apnea hypopnea syndrome (OSAHS) before and after the use of mandibular protrusion snoring device (MASSD), and to provide a reference and basis for the treatment of mild and moderate OSAHS patients with mild, moderate and moderate snoring apparatus (MASSD) for the treatment of moderate and moderate OSAHS patients. [Methods] choose 2 2015. In the Department of Stomatology, Yanan Hospital Affiliated to Kunming Medical University, January, 30 cases of mild and moderate OSAHS were diagnosed by polysomnography and 30 patients with moderate OSAHS were excluded, and other patients with airway obstruction and anatomic abnormalities were excluded. Among them, there were 9 males, 9 women, 25-59 years old, and the average age of 49 years. CBCT scan, using the InVivo Dental software to reconstruct the three-dimensional shape of the upper airway, determine the measurement plane and partition of the airway, measure the sagittal diameter, the coronal diameter, the minimum cross section area and the volume of each section of the upper airway, and compare the changes in the index of the respiratory disturbance index (AHI) and the lowest oxygen saturation (LSaO2) before and after the treatment. According to the SPSS21.0 software package, the self matched t test was used. [results]1.30 cases were light, the subjective symptoms of moderate OSAHS patients were obviously improved after using the mandibular protrusion snoring device, such as no subjective waking up, the daytime sleepiness symptoms improved obviously. There were occasional discomfort in the early Dai snoring device, such as the pain of the teeth in the morning and the discomfort of the dry mouth, and the objective index of.2. without obvious adverse reaction. The snoring times did not obey the normal distribution, and the result was P50 (P25, P75), and the difference was statistically significant before and after the treatment, and the difference was not MA. The AHI index at SSD (20.61 + 5.19) and AHI index (10.86 + 4.31) after wearing MASSD were significant (P0.001); the lowest oxygen saturation (LSaO2) was (0.78 + 0.08) without MASSD, and the lowest oxygen saturation (LSaO2) (0.92 + 0.03) in MASSD (P0.001) was significant (P0.001).3. light, the soft palate of moderate OSAHS patients The sagittal diameter of the lower margin of MASSD (7.01 + 1.43mm) and the sagittal diameter (14.78 + 1.36 mm) after the insertion of MASSD had significant statistical significance (P0.001). The coronal diameter of the lower margin of the soft palate (20.46 + 1.24 mm) and the crown diameter of MASSD (28.35 + 1.85mm) had significant statistical significance (P0.001); the lower margin of the epiglottis was not used MA. The SSD sagittal diameter (9.58 + 0.95mm) and the sagittal diameter (13.75 + 0.77mm) after the insertion of MASSD had significant statistical significance (P0.001). The coronal diameter of the inferior epiglottis without MASSD (19.86 + 2.06mm) and the posterior crown diameter of MASSD (26.72 + 2.25mm) had significant statistical significance (P0.001), while the hard recruitment plane did not wear MASSD time (12.57 + 1). .30mm), there was no statistically significant difference in the sagittal diameter (12.01 + 1.04mm) after the insertion of MASSD, and the coronary diameter (27.49 + 2.92 mm) without MASSD in the hard recruitment plane, and the posterior crown diameter of MASSD (29.20 + 4.17mm). The difference was not statistically significant (P0.05). It was indicated that the coronal diameter of the lower margin of the soft palate and the epiglottis upper margin was obvious after the insertion of MASSD. The coronary diameter was obvious. There was no obvious change in the plane of the hard palate.4., and the minimum cross section area (72.84 + 20.93 mm2) in the soft palate posterior region of the moderate OSAHS patients, the minimum cross section area (129.30 + 26.37mm2) after the insertion of MASSD (129.30 + 26.37mm2), and the smallest cross-sectional area (139.54 + 35.13mm2) in the posterior region of the tongue (139.54 + 35.13mm2), and the most in MASSD. The small cross section area (188.42 + 37.08mm2) has significant statistical significance (P0.001); the minimum cross section area (112.51 + 13.69mm2) in the posterior epiglottis area without MASSD is (220.81 + 22.04mm2), and the difference has significant statistical significance (P0.001). The minimum cross section area (72.84 + 20.93 mm2) when the total airway is not worn and MASSD, is put into M. The minimum cross section area (129.30 + 26.37mm2) after ASSD was statistically significant (P0.001). It showed that the minimum cross section area in the posterior region of the soft palate of the airway, the posterior region of the tongue, and the posterior region of the epiglottis obviously increased after the insertion of MASSD, and found that the most obstructed part in the posterior region of the soft palate was.5. light, and the volume of the posterior region of the soft palate in the moderate OSAHS patients had no MASSD volume (4.99 +). 0.60cc), the volume (8.15 + 0.68cc) after the entry of MASSD had significant statistical significance (P0.001), the volume of the posterior region of the tongue was not MASSD (4.12 + 0.45cc), and the volume (7.31 + 0.59cc) after the insertion of MASSD (7.31 + 0.59cc). The volume of the posterior region of the epiglottis was (2.68 + 0.23cc), and the volume (3.82 +) after being put into MASSD (3.82 +). Significant statistical significance (P0.001); the volume of the total airway volume was not MASSD (11.79 + 0.87cc) and the volume (19.31 + 1.11cc) after the entry of MASSD. The difference was statistically significant (P0.001). The total volume of the upper airway and the posterior region of the tongue, the posterior region of the tongue, and the posterior region of the epiglottis were increased. [conclusion]1. MASSD treatment). Mild treatment, moderate OSAHS patients have good clinical efficacy; 2.CBCT Muller breathing seat scan, wear MASSD to reduce the upper airway and coronary diameter of mild and moderate OSAHS patients; 3. wear MASSD to open the airway of mild, moderate OSAHS patients, increase the upper airway ventilation, and thus improve the respiratory function of patients, for the clinical diagnosis and treatment of OSAHS. Work provides theoretical guidance.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766

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