阻塞性睡眠呼吸暂停低通气综合征患者的上气道睡眠动态MRI研究

发布时间：2018-07-01 20:12

  本文选题：阻塞性睡眠呼吸暂停低通气综合征 + 磁共振　； 参考：《郑州大学》2017年硕士论文

【摘要】：阻塞性睡眠呼吸暂停低通气综合症(obstructive sleep apnea hypopnea syndrome,OSAHS)是指睡眠时上气道塌陷阻塞引起的睡眠呼吸暂停和通气不足、伴有打鼾、睡眠结构紊乱,频繁发生血氧饱和度下降、白天嗜睡等病症,目前该病主要以持续气道正压(CPAP)以及手术治疗为主,手术方法主要是改良的悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)为主,未经筛选的OSAH S手术成功率仅可达到50%左右,因此,阻塞部位的确定对于手术成功率及手术预后起到至关重要的作用。本研究中应用动态MRI对OSAHS患者的上气道进行清醒及睡眠状态下上气道扫描,对扫描所获得的相关数据与多导睡眠监测指数进行相关性分析,同时将纤维喉镜下Müller试验与MRI检查结果进行对比,进一步探索这两种OSAHS患者术前检查的优势及不足。一阻塞性睡眠呼吸暂停低通气综合征患者的软腭后区及舌骨位置的睡眠动态MRI研究目的通过对来院就诊的阻塞性睡眠呼吸暂停低通气综合征患者行术前睡眠及清醒状态下的上气道动态MRI检查,确定其上气道阻塞部位,为手术方案的制定提供依据。同时,将患者软腭后区径线数据、舌骨的位置高低与多导睡眠监测的数据之间加以分析,找出之间的联系并进一步探讨疾病的发病机制。方法前瞻性分析了于2015年2月~2015年10月就诊于郑州大学第一附属医院咽喉头颈外科的25例阻塞性睡眠呼吸暂停低通气综合征患者的临床资料,入院后于我科行多导睡眠监测以明确诊断,确诊的患者分别于清醒及睡眠状态下行上气道的动态MRI扫描,明确患者睡眠状态下的上气道阻塞部位,并将扫描获得的软腭后区径线变化幅度、舌骨的垂直移动距离与多导睡眠监测所获得的部分参数进行相关性研究,其中6名患者因MRI检查过程中无法自然入睡未被纳入研究。结果1.软腭后区相关测量指标与AHI的相关性分析结果19例被纳入研究的患者中,多重部位阻塞者6例,单纯软腭后阻塞者13例,患者睡眠状态下软腭后最小前后径与血氧饱和度低于90%时间占总检测时间百分比(CT90%)具有相关性(r=0.474,p0.05),软腭后最小左右径与CT90%(r=0.510,p0.05)以及最低血氧饱和度(LSa O2)(r=0.546,p0.01)具有相关性,前后径变化幅度与睡眠呼吸暂停低通气指数(AHI)(r=0.622,p0.01)、CT90%(r=0.581,p0.01)及最低血氧饱和度(LSa O2)(r=-0.496,p0.05)均具有相关性,左右径变化幅度与AHI(r=0.476,p0.05)、CT90%(r=0.839,p0.05)及LSa O2(r=-0.777,p0.01)均具有相关性。2.舌骨位置与AHI的相关性分析结果睡眠状态下患者舌骨垂直活动度大于清醒状态下舌骨的垂直活动度。本次研究数据表明,舌骨最低位置与术前AHI呈正相关(r=0.473,p0.05),舌骨垂直活动度与最低血氧饱和度成负相关(r=-0.437,p0.05),舌骨垂直活动度与CT90%成正相关(r=0.665,p0.01)。结论睡眠状态下上气道动态MRI可如实反映阻塞性睡眠呼吸暂停低通气综合征患者的上气道塌陷情况,软腭后径线及舌骨位置可能影响疾病严重程度。二应用动态磁共振及纤维喉镜对阻塞性睡眠呼吸暂停低通气综合症患者的术前检查对比研究目的应用动态磁共振及纤维喉镜下Müller试验检查对阻塞性睡眠呼吸暂停低通气综合征患者进行术前上气道阻塞部位的定位,对比两者的检查效果,探讨其临床应用价值。方法选取2015年10月-2016年4月到郑州大学第一附属医院咽喉头颈外科就诊并经多导睡眠监测(PSG)及专科检查确诊的阻塞性睡眠呼吸暂停低通气综合症患者共计28例,分别于术前行纤维喉镜下Müller试验检查和睡眠及清醒状态下动态磁共振检查,检查软腭区、舌后区及会厌区狭窄或阻塞发生情况,其中6例患者因磁共振检查过程中无法自然入睡未被纳入研究。结果电影磁共振与纤维喉镜下Müller试验对于软腭区阻塞的定位(22例对22例)具有完全的一致性,而对于舌后区(13例对6例)、会厌区(4例对2例)及多部位同时阻塞的定位(13例对6例),二者一致性一般。结论对多部位阻塞的中重度OSAHS患者,术前同时应用睡眠动态磁共振及纤维喉镜检查能够更好明确阻塞部位,结合我们的检查结果所示,对于多部位阻塞的OSAHS患者,睡眠动态磁共振的检查结果明显优于纤维喉镜。
[Abstract]:Obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea hypopnea syndrome, OSAHS) refers to sleep apnea and hypoventilation caused by upper airway collapse obstruction during sleep, accompanied by snoring, disorder of sleep structure, frequent descent of oxygen saturation and daytime sleepiness, and the disease is currently mainly due to continuous airway correction. Pressure (CPAP) and surgical treatment mainly, the main operation method is the modified uvulopalatopharyngoplasty (uvulopalatopharyngoplasty, UPPP), and the success rate of the unscreened OSAH S operation is only about 50%. Therefore, the determination of the blocking site plays a vital role in the success rate of the operation and the prognosis of the operation. The upper airway of OSAHS patients was sober and the upper airway scan was scanned in the sleep state. The correlation data obtained by the scan were correlated with the polysomnography index, and the M u ller test under the fiberoptic laryngoscope and the results of MRI examination were compared to further explore the advantages and disadvantages of these two OSAHS patients before operation examination. The dynamic MRI study of the posterior area of the soft palate and the position of the hyoid in the patients with obstructive sleep apnea hypopnea syndrome objective to determine the upper airway obstruction in the patients with obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea hypopnea syndrome) in patients with obstructive sleep apnea hypopnea syndrome, and to determine the location of the upper airway obstruction. At the same time, the data of the posterior area line of the soft palate, the position of the hyoid bone and the data of polysomnography were analyzed to find the connection and further explore the pathogenesis of the disease. Methods to look forward to the pharynx and neck surgery of the First Affiliated Hospital of Zhengzhou University in October ~2015 February 2015. The clinical data of 25 patients with obstructive sleep apnea hypopnea syndrome were admitted to our department after admission to the Department of polysomnography to make a clear diagnosis. The patients were diagnosed with dynamic MRI scan on the upper airway in sober and sleep state. The upper airway obstruction position in the patient's sleep state was clearly defined and the posterior area of the soft palate was scanned. The range of variation, the vertical distance of the hyoid bone and the partial parameters obtained by the polysomnography, 6 of the patients were not included in the study during the MRI examination. Results 1. the correlation analysis of the relative measurements of the posterior palate area and the correlation of the AHI was found in 19 patients who were included in the study. In 6 patients and 13 patients with simple soft palate obstruction, the minimum posterior diameter of the soft palate and the percentage of oxygen saturation less than 90% of the total detection time (CT90%) were related (r=0.474, P0.05), and the smallest diameter after the soft palate was correlated with CT90% (r=0.510, P0.05) and the lowest oxygen saturation (r=0.546, P0.01). The change amplitude of the anterior and posterior diameter was correlated with the sleep apnea hypopnea index (AHI) (r=0.622, P0.01), CT90% (r=0.581, P0.01) and the lowest oxygen saturation (r=-0.496, P0.05). The results showed that the minimum position of hyoid bone was positively correlated with preoperative AHI (r=0.473, P0.05), and the vertical degree of hyoid activity was negatively correlated with the lowest oxygen saturation (r=-0.437, P0.05), and the vertical activity of hyoid bone and CT90% were positive. Correlation (r=0.665, P0.01). Conclusion the upper airway dynamic MRI under sleep can accurately reflect the upper airway collapse in patients with obstructive sleep apnea hypopnea syndrome. The soft palate posterior diameter and the hyoid position may affect the severity of the disease. Two the application of dynamic magnetic resonance and fiberoptic laryngoscope to obstructive sleep apnea hypopnea syndrome The preoperative examination and comparison of the patients with M u ller test under the dynamic magnetic resonance and fiberoptic laryngoscopy for the location of the upper airway obstruction in the patients with obstructive sleep apnea hypopnea syndrome, compare the results of the two, and discuss the value of its clinical application value. Methods selected from April to Zhengzhou in October 2015, to Zhengzhou. A total of 28 patients with obstructive sleep apnea hypopnea syndrome diagnosed in the First Affiliated Hospital of the First Affiliated Hospital of the University were diagnosed with polysomnography (PSG) and specialized examination. The M u ller test under fiberoptic laryngoscope and dynamic magnetic resonance examination under sleep and awake state were performed before the operation. The stenosis or obstruction occurred in the region, of which 6 patients were unable to fall asleep naturally during magnetic resonance examination. Results the film magnetic resonance and the M u ller test under the fiberoptic laryngoscope were completely consistent for the location of the soft palate block (22 cases of 22 cases), but for the posterior region of the tongue (6 cases in 13 cases), the epiglottis area (4 cases 2 cases) and multiple parts. Concomitant occlusion (13 cases of 6 cases) and the consistency of the two were common. Conclusions for patients with moderate to severe OSAHS with multiple site obstruction, preoperative sleep dynamic magnetic resonance and fiberoptic laryngoscopy can better identify the blocking sites. Combined with our findings, the dynamic MRI of sleep dynamic MRI for multiple obstructive OSAHS patients is examined. The results were obviously superior to that of fibrous laryngoscopy.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766
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本文编号：2089025