可调型下颌前移类矫治器治疗OSAHS上气道容积变化与相关因素分析

发布时间：2018-05-21 03:22

本文选题：阻塞性睡眠呼吸暂停低通气综合征 + 上气道　；参考：《山东大学》2010年硕士论文

【摘要】： 研究目的比较阻塞型睡眠呼吸暂停低通气综合征(OSAHS)患者戴用可调型下颌类前移矫治器前后上气道容积的变化,并对有关因素,如：体块指数(BMI)、下颌平面角(FH-MP)、AHI改变量(AAHI)等进行相关性分析,探索下颌前移类矫治器治疗OSAHS的机制。研究对象和方法选取9名经主观症状、EDS评价和PSG监测,诊断为轻中度OSAHS的患者。根据患者的PSG监测结果、患者睡眠状况和EDS得分,制作可调型拉杆式下颌前移类矫治器并调整至最佳位置。患者戴用下颌前移类矫治器3个月后,再进行PSG监测和EDS评分,并分别于不戴矫治器和戴用矫治器时进行CT拍摄。应用CT三维重建软件VGstudio MAXv1.2进行上气道三维重建,测量戴用下颌前移类矫治器前后腭咽、舌咽、喉咽各段的容积和上气道容积(腭咽、舌咽、喉咽容积之和)。比较戴用下颌前移类矫治器前后各段气道的容积变化,并用统计学方法对与容积变化可能有关的相关因素,如体块指数(BMI)、下颌平面角(FH-MP)、治疗前AHI(AHI前)、治疗前后AHI变化量(△AHI)进行相关性分析。结果 1.9名患者中,8名患者戴用下颌前移类矫治器后显效(呼吸暂停、打鼾明显减轻,AHI20和降低50%)；1名患者戴用下颌前移类矫治器治疗无效(AHI降低25%)。本实验中下颌前移类矫治器的治疗有效率为88.89%。 2.戴用下颌前移类口腔矫治器后,上气道腭咽容积增加明显(从2340.22±306.26 mm3增加到3277.67±498.10 mm3,增加了41.21±17.25%,p0.001)；舌咽容积增加明显(从3163.89±313.78 mm3增加到4538.00±548.37 mm3,增加了43.51±17.07%,p0.001)；喉咽容积增加较少(3321.33±286.81 mm3增加到3629.33±335.96 mm3,增加了9.35±8.51%,p0.05)；上气道总容积增加明显(从8864.67±865.54mm3增加到11670.33±1423.05mm3,增加了32.36±14.58%P0.001)。 3.上气道容积的改变(△volume％)与患者戴用矫治器前后AHI的改变量(AAHI)有明显相关性(r=0.71,P=0.03)。 4.上气道容积的改变(△volume％)与戴用矫治器前AHI(AHI前)没有明显相关性(r=0.56,P=0.12)。 5.上气道容积的改变(△volume％)与患者BMI呈负相关(r=-0.70,P=0.03),表明患者体块指数越大,上气道容积增加越少。 6.上气道容积的改变(△volume％)与患者下颌平面角(FH-MP)无明显相关性(r=-0.43,P=0.25)。结论 1.下颌前移类矫治器可改变气道大小,使气道容积明显增大,尤其是腭咽和舌咽段容积显著增大,是治疗轻、中度OSAHS的一种有效方法。 2.下颌前移引起的上气道容积的改变与AHI改变量呈正相关,即上气道容积增加越多,患者呼吸状况改善越多；而上气道容积的改变与患者体块指数呈负相关性,即体块指数越大,上气道容积改变越小 3.本实验研究结果不能证明下颌前移引起的上气道容积的改变与治疗前AHI、下颌平面角(FH-MP)没有显著相关性,即上气道容积的改变与治疗前OSAHS的严重程度、患者的下颌平面角大小没有显著关系。
[Abstract]:research objective
The changes of upper airway volume in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) with adjustable mandibular forward shift appliance were compared, and related factors, such as body mass index (BMI), mandibular plane angle (FH-MP) and AHI change (AAHI), were analyzed to explore the mechanism of mandibular anterior shift appliance in the treatment of OSAHS.
Research objects and methods
9 patients with mild and moderate OSAHS were selected by subjective symptoms, EDS evaluation and PSG monitoring. According to the PSG monitoring results of the patients, the patients' sleep status and EDS score were made and the adjustable pull rod type mandibular forward orthodontic appliance was made and adjusted to the best position. After 3 months of the mandibular anterior shift orthodontic appliance, the patients were followed by PSG monitoring and EDS score. CT was taken without wearing appliances or appliances.
CT 3D reconstruction software VGstudio MAXv1.2 was used to reconstruct the upper airway, and the volume and volume of the upper airway (palatopharynx, glossopharynx and laryngopharynx volume) were measured before and after the mandibular forward shift appliance, and the volume changes of the airway in the anterior and posterior segments of the mandibular anterior shift appliance were compared with the statistical method. Relative factors related to volume change, such as body mass index (BMI), mandibular plane angle (FH-MP), pre treatment AHI (AHI), and AHI changes before and after treatment (delta AHI) were analyzed.
Result
Of the 1.9 patients, 8 patients were displayed after the mandibular forward orthodontic appliance (apnea, snoring, AHI20 and 50%), and 1 patients were treated with mandibular forward orthodontic appliance (AHI 25%). The effect of the mandibular forward orthodontic therapy was 88.89%. in this experiment.
2. after the mandibular forward orthodontic appliance, the upper airway palatopharyngeal volume increased significantly (from 2340.22 + 306.26 mm3 to 3277.67 + 498.10 mm3, increased 41.21 + 17.25%, p0.001), the glossopharyngeal volume increased significantly (from 3163.89 + 313.78 mm3 to 4538 + 548.37 mm3, plus 43.51 + 17.07%, p0.001), and the volume of laryngopharynx increased less. The increase of 33 + 286.81 mm3 to 3629.33 + 335.96 mm3, increased by 9.35 + 8.51%, P0.05), the increase of total volume of upper airway (from 8864.67 + 865.54mm3 to 11670.33 + 1423.05mm3, increased by 32.36 + 14.58%P0.001).
3. the change of upper airway volume (delta volume%) was significantly correlated with the amount of AHI (AAHI) before and after wearing the appliance (r=0.71, P=0.03).
4. there was no significant correlation between the volume of upper airway (delta volume%) and AHI before wearing the appliance (AHI before) (r=0.56, P=0.12).
5. the change of upper airway volume (delta volume%) was negatively correlated with BMI (r=-0.70, P=0.03), indicating that the larger the body mass index, the smaller the upper airway volume.
6. there was no significant correlation between the change of upper airway volume (delta volume%) and the mandibular plane angle (FH-MP) of the patients (r=-0.43, P=0.25).
conclusion
The 1. mandibular forward moving appliance can change the size of the airway and increase the volume of the airway obviously, especially the volume of palatopharynx and glossopharyngeal segment, which is an effective method for the treatment of mild and moderate OSAHS.
2. the change of upper airway volume caused by the forward movement of the mandible is positively correlated with the amount of AHI change, that is, the more the volume of the upper airway is increased, the more the patient's respiratory condition is improved, and the change of upper airway volume is negatively correlated with the volume index of the patient, that is, the larger the volume index, the smaller the change of the volume of the upper airway.
3. the results of the study do not prove that the change of the upper airway volume caused by the mandibular forward movement has no significant correlation with the pre treatment AHI and the mandibular plane angle (FH-MP), that is, the changes in the volume of the upper airway and the severity of the OSAHS before treatment have no significant correlation with the size of the mandibular plane angle.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R766

【参考文献】