实时CT扫描与光纤内镜技术对阻塞性睡眠呼吸暂停低通气综合征上气道阻塞定位的对比研究

Comparative study of determining the sites of airway obstruction in obstructive sleep apnea hypopnea syndrome between real-time CT scans and laryngofiberscope technology

目的比较睡眠状态下256层螺旋cT扫描与光纤内镜技术在阻塞性睡眠呼吸暂停低通气综合征（OSAHS）上气道定位诊断的符合率及优缺点，探讨其临床应用价值。方法对海军总医院耳鼻咽喉头颈外科2011年4月至2012年7月收治的59例经多导睡眠监测确诊的OSAHS患者分别行清醒、诱导睡眠状态下上气道螺旋cT扫描及清醒状态下光纤内镜检查，判定OSAHS患者的上气道阻塞部位，行前瞻I生研究。结果所有患者均顺利完成实时CT扫描。（1）发现单纯软腭后区阻塞或狭窄者，实时cT26例，光纤内镜检查34例；发现软腭后区＋舌后区阻塞或狭窄者，实时cT19例，光纤内镜检查10例；发现软腭后区＋会厌后区阻塞或狭窄者，实时CT6例，光纤内镜检查2例；发现软腭后区＋舌后区＋会厌后区阻塞或狭窄者，实时CT7例，光纤内镜检查3例；软腭后区＋舌后区＋会厌后均未见阻塞或狭窄者，实时CT1例，光纤内镜检查10例；实时CT与光纤内镜检查均未发现单纯舌后区及会厌后区狭窄或阻塞者。（2）对比两种方法判定OSAHS患者软腭后区、舌后区、会厌后区阻塞或狭窄阳性率，实时CT扫描阳性率均高于光纤内镜检查，差异均有统计学意义（均P〈0．05）[软腭后区：98．3％（58例）比81．4％（48例），X2=5．82，P〈0．05；舌后区：44．1％（26例）比22．0％（13例），x。=9．60，P〈0．01；会厌后区：22．0％（13例）比8．5％（5例），）（z=4．90，P〈0．05]。结论药物诱导睡眠实时CT扫描较之光纤内镜检查可获得更多上气道解剖学信息，可为OSAHS诊治提供更为全面、客观的形态学依据。

Objective To compare 256-layer spiral computed tomography （CT） scan in sleep and laryngofiberscope technology for locating obstructive sites of upper airway in patients with obstructive sleep apnea hypopnea syndrome, analyze their advantages and disadvantages and discuss the clinical application values. Methods A total of 59 patients with OSAHS diagnosed by polysomnography underwent spiral CT scan in awake and drug-induced sleep states and laryngofiberscope examination in awake state to assess the sites of airway obstruction. Results Real-time CT scans were completed successfully in all patients. There were airway obstruction at isolated retropalatal region （real-time CT revealing n = 26, laryngofiberscope revealing n = 34 ）, retropalatal and retroglottal regions simultaneously （ real-time CT revealing n = 19, laryngofiberscope revealing n = 10 ）, retropalatal and epiglottal regions simultaneously （real-time CT revealing n = 6, laryngofiberseope revealing n = 2 ）, retropalatal and retroglottal and epiglottal regions simultaneously （ real-time CT revealing n = 7, laryngofiberscope revealing n = 3 ） and no airway obstruction （real-time CT revealing n = 1, laryngofiberseope revealing n = 10）. There was not solitary airway obstruction at retroglottal or epiglottal region. The results of real-time CT scans and laryngofiberscope examination were statistically significant different in all regions, and real-time CT scanning compared with laryngofiberscope found more obstructive sites of upper airway [ retropalatal region： 98.3% （n = 58） vs 81.4% （n = 48 ）, x5 = 5.82, P 〈 0. 05 ; retroglottal regions ： 44. 1% （ n = 26 ） vs 22. 0% （ n = 13 ）, x2 = 9. 60, P 〈 0. O1 ; epiglottal regions ： 22. 0% （ n = 13 ） vs 8.5 % （ n = 5 ）, X2 = 4. 90, P 〈 0. 05 ]. Conclusion Compared with laryngofiberseope examination, real-time dynamic CT scans in drug-induced sleep state could get more information about anatomy changes of upper airway, providing relatively objective morphological basis for diagnosis and treatment of patients with OSAHS.