阻塞性睡眠呼吸暂停低通气综合征患者及正常成人呼吸运动周期中上气道形态变化的研究

Difference of upper airway variety with respiration in the sufferer of OSAHS and normal adult

目的:通过观察呼吸运动周期中阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者与正常人上呼吸道形态变化的差别,探讨OSAHS的发病机制。方法:选取经PSG确诊的OSAHS患者20例和均无睡眠疾病方面主诉的正常对照组16例。利用PSG中呼吸监测系统记录其呼吸周期曲线,同时采用纤维内镜观察受检者在平静呼吸的呼吸周期中咽腔形态学的改变,将纤维内镜观察过程同步录制于PSG同一计算机内。后期根据呼吸曲线,分别于呼吸周期各个不同时相所对应的咽腔录像利用图像软件剪接为照片,分别测量各解剖区不同呼吸周期下上呼吸道的横截面积、左右径和前后径。结果:对照组与OSAHS组均表现为上呼吸道形态随呼吸运动而变化。吸气时面积开始减小,吸气中期呼吸道面积减至最小,持续到吸气末期,呼气时面积开始增大,呼气中期面积增至最大,持续到呼气末期,吸气相再次开始。对照组与OSAHS组在腭咽区和舌咽区的前后径、左右径及横截面积在呼吸运动中有明显变化。OSAHS组在腭咽区及舌咽区左右径、前后径及横截面积变化幅度均大于对照组。OSAHS组与对照组呼吸周期内腭咽区左右径及面积变化幅度均明显大于舌咽区及喉咽区。OSAHS组腭咽区前后径变化幅度也大于舌咽区及喉咽区。结论:呼吸运动周期中上呼吸道的形态存在周期性的变化,OSAHS患者的变化幅度明显大于对照组,这种较大的变化幅度是OSAHS患者睡眠中发生上呼吸道阻塞的基础。

Objective：To inquiry the variety difference of upper airway caliber OSAHS sufferer and normal person in quiet respiration.Method：Twenty OSAHS sufferer who were viewed by PSG and 16 normal adults who hadve no chief complaint of sleeping disease were selected. The curves of the subjects in a respiratory cycle were recorded by respiratory monitoring system in PSG,while the morphological changes in the pharynx of all subjects were observed by fiberscope in a calm respiratory cycle,and then both of the two processes simultaneously were recorded on the same computer. According to the different stages of respiratory cycle by analyzing respiratory curve the video had been edited into pictures about the various anatomical areas in the upper airway,the cross section area and the dimension of palate and lingua and root of the tongue region upper airway wereas studied by the image tools in computer,and the changes of areas and dimensions at palate,and lingua and root of the tongue region upper airway were calculated.Result：It was found that there wasis a morphological change of the upper airway with the respiratory movement in the both groups. The upper airway caliber decrease with inspiration begin and reach the most narrowing at the end of inspiration ,then upper airway caliber enlarges with the expiration begin and reach the most widening at the end of expiration. No matter the normal group or the OSAHS group has the obvious changes in the palate and lingua region on the diameter,the cross section area and the dimension in respiration. The changes in the palate and lingua region on the diameter,the cross section area and the dimension of OSAHS group were greater than normal group. No matter OSAHS group or normal group on the diameter and cross section area change in the palate was obviously more than the tongue area and the root of tongue area. The changes of OSAHS group on the dimension in the palate were greater than the tongue area and the root of tongue area.Conclusion：There are periodically changes of upper airway during respiration cycle in normal adults and OSAHS patients. The effects of respiration on upper airway caliber of OSAHS patients are more obviously than normal adults,and the increasing effects in OSAHS patients is one of OSAHS etiology.