急性脑梗死患者上气道形态变化

Morphologic changes in the upper airway in patients with acute cerebral infarction

目的了解急性脑梗死患者的上气道形态变化特点，探讨脑梗死新的防治途径。方法选取经MRI确诊的病程小于3周的脑梗死患者，均行上气道MRI及多导睡眠图（PSG）检查，患者被分为阻塞性睡眠呼吸暂停低通气（OSAHS）组（50例），非OSAHS组（16例），另设无脑梗死的OSAHS组（16例）。3组分别测量鼻咽、腭咽、口咽和喉咽的气道截面积，各段前后、左右径和软腭厚度、长度及截面积，将各项测量指标进行统计学分析。结果66例脑梗死患者完成上气道MRI及PSG检查，50例（75．8％）符合OSAHS诊断标准。脑梗死伴OSAHS组上气道各段前后径、左右径和最小截面积均小于脑梗死不伴OSAHS组及无脑梗死组，上气道最狭窄处为鼻咽和口咽，其截面积的减小主要由于左右径的缩短所致。脑梗死伴OSAHS组软腭各指标均大于脑梗死不伴OSAHS组，软腭截面积[分别为（452．2±99．6）mm^2和（350．0±69．4）mm^2]的增大有统计学意义（t=4．575，P〈0．05）。3组中脑梗死伴OSAHS组最低血氧饱和度值最低（68．9％±10．5％）。上气道狭窄越严重睡眠呼吸暂停低通气指数（AHI）值越大，平均最低血氧饱和度越低。结论急性脑梗死患者OSAHS发生率高，存在严重的、多水平的上气道狭窄，提示上气道狭窄可能是早期干预、改善脑梗死患者预后和转归的新靶点。

Objective To investigate the feature of the morphology changes in the upper airway in patients with acute cerebral infarction and to find a new method to prevent and cure cerebral infarction. Methods Sixty-six patients with cerebral infarction confirmed by brain MRI or CT scan （within 3 weeks of onset） were recruited. The patients were examined by upper airway MRI scan and polysomnography （PSG）. Then the patients were divided into obstructive sleep apnea hypopnea syndrome （OSAHS） group and non-OSAHS group. In addition, 16 patients showing OSAHS but without stroke history （OSAHS non-stroke group ） were included in the study. The sagittal and horizontal lengths of the nasopharynx, pa/atopharynx, glossopharynx and hypopharynx were measured and their cross-sectional areas were calculated. The length, thickness and cross-sectional area of the palate were also measured. Statistic analysis of each data among the groups was performed using SPSS software. Results Among 66 cases with acute cerebral infarction, 75.8% （50/66） were diagnosed with OSAHS. The anteroposterior diameter, left and right diameters and smallest section area in upper airway were all smaller in the OSAHS group with acute cerebral infarction than those in the non-OSAHS group and OSAHS non-stroke group. The narrowest segments in upper airway were nasopharynx and oropharynx, which are caused bv shortened left and right diameters. The area of the soft palate in the OSAHS-stroke group was significant bigger （ （452. 2 ± 99. 6 ） mm2 ） than that in non-OSAHS group （ （ 350. 0 ± 69.4 ） mm^2, t = 4. 575, P 〈 0. 05 ）. The lowest S02 in OSAHS-stroke group （68.9% ＋ 10. 5% ） was the lowest among three groups. The more severe the airway constriction was, the higher the apnea-hypopnea index （AHI） was and the lower the lowest S02 was. Conclusion Patients with stroke show higher incidence of OSAHS and present more severe multilevel upper airway constriction. Upper airway constriction may be the new target of early treatment for better prognosis of cerebral infarction.