平静呼吸状态下MSCT评价上气道狭窄

MSCT evaluation for narrowing of upper airway under quiet breathing

目的观察平静呼吸状态下应用多层螺旋CT判定阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者上气道狭窄的价值。方法应用16层螺旋CT对63例OSAHS患者分别行吸气、呼气、平静呼吸状态下的上气道扫描,对比分析不同呼吸时相下软腭的状态及腭后区、舌后区咽腔最狭窄处的大小,并与多导睡眠监测结果进行相关性分析。结果14例患者在不同呼吸时相中均有出现悬雍垂远端上翘、软腭上抬及运动伪影等情况,其中呼气时相出现的机会较多。平静呼吸时相的腭后区最小面积最小,三种不同呼吸时相间差异有统计学意义(F=4.602,P<0.05),其中吸气时相的腭后区最小面积与平静呼吸、呼气时相的差异有统计学意义,呼气时相与平静呼吸时相组间差异无统计学意义;舌后区最小面积于不同呼吸时相间差异无统计学意义。呼气时相和平静呼吸的腭后区最小面积均与LSaO2呈正相关,r值分别为0.300和0.511(P<0.05)。结论当患者不能配合或者呼气时相出现不利于测量的因素时,平静呼吸状态下的上气道MSCT扫描是评价上气道狭窄的较好方法。

Objective To assess the value of upper airway narrowing with MSCT under quiet respiration in patients with the obstructive sleep apnea-hypopnea syndrome（OSAHS）.Methods CT scan of upper airway was performed in 63 patients with OSAHS during inspiration,expiration and quiet respiration respectively with 16-slice spiral CT.The state of the soft palate,the area of the smallest cross-sectional area of retropalatal and retroglossal space of the upper airway during the different respiratory phase were compared.The correlation between these dimensions and the polysomnography（PSG） results were analyzed.Results Some particular pattern of events occurred in 14 patients during the different phase of respiration,such as hooking of the soft palate,raising of the soft palate,artifacts,etc.These events occurred more often in the expiration phase.The cross-sectional area of the retropalatal space was the smallest during quiet breathing.There were statistically significant differences in the smallest cross-sectional area of retropalatal space among different phases of respiration（F =4.602,P 0.05）,also between inspiration and expiration,quiet breathing groups.No statistically significant difference was found between expiration and quiet breathing,nor in the smallest cross-sectional areas of retroglossal space among the three groups（P 0.05）.There was positive correlation between the smallest area of retropalatal space and LSaO 2 in quiet breathing and expiration groups（r=0.511,0.300,P 0.05）.Conclusion MSCT scan of upper airway may be a better way to evaluate upper airway narrowing under quiet breathing when patients failed to carry out the required mode（keeping exhalation） or some undesirable events occurred.