电子鼻咽喉镜研究鼾症儿童上气道结构

Study of Upper Airway Structure in Snoring Children with Electronic Pharyngorhinoscopy

目的用电子鼻咽喉镜研究鼾症儿童上气道结构和气道塌陷性。方法 79例阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患儿(轻度36例,中重度43例),41例原发性打鼾(primary snoring,PS)和45例对照组行电子鼻咽喉镜检查,比较各组腺样体占后鼻孔的比例(ANR)及各咽腔塌陷程度,同时将ANR、咽腔塌陷度与呼吸暂停低通气指数(apnea hyponea index,AHI)行相关分析。结果 4组患儿ANR、咽腔塌陷度比较差异有统计学意义(P均<0.05),鼾症组ANR两两比较示中重度OSAHS组最大(P<0.05),轻度其次,PS组最小(P<0.05),咽腔塌陷度中重度最大(P<0.05),轻度OSAHS组与PS组比较,差异无统计学意义(P>0.05),相关分析示ANR、腭咽腔前后径、腭咽腔塌陷度、舌咽腔左右径、舌咽腔塌陷度与AHI呈正相关;腭咽腔左右径、舌咽腔前后径塌陷度与AHI无相关关系。结论 ANR、咽腔易塌陷性增强与OSAHS病情严重程度有关,电子鼻咽喉镜结合Müller's检查在鼾症儿童上气道形态学研究中有一定价值,能反映腺样体堵塞程度及咽腔顺应性。

Objective To study the upper airway structure and pharyngeal collapsibility among snoring children under electronic pharynxgorhinoscopy. Methods Patients were distributed into three groups according to the apnea- hypopnea index： mild obstructive sleep apnea- hypopnea group（36 cases ） , moderate to severe OSAHS group（43 cases ） and Primary snoring group（41 cases）. 45 unsn- oring children were selected as control group. The adenoid - nasopharynx ratio （ANR） and pharyngeal collapsibility among these groups were compared by using electronic pharyngorhinoscopy with Muller＇s maneuver（EPMM）. Meanwhile the correlation between the degree of adenoidal blocks postnaris, pharyngeal collapsibility with snoring children and the apnea -hypopnea index （AHI） was studied. Results Differences in adenoid - nasopharynx ratio （ANR） and pharyngeal collapsibility among the four groups were significant. The ANR and the degree of pharyngeal collapse in snoring children groups were significantly higher than the control group. Patients with moderate to severe OSAS had significantly higher adenoid - nasopharynx ratio compared with patients with mild OSAS （ P 〈 0. 05 ） and the PS group （ P 〈 0.05 ）. As to the pharyngeal collapsibility, the moderate to severe OSAHS group was the maximum （ P 〈 0.05 ） , and there was no statisti- cal differences between PS group and mild OSAHS group（P 〉 0.05 ）. The correlation between adenoid -nasopharynx ratio and AHI were all positive and significant（P 〈 0.05）. There was a statistically significant correlation between apnea- hypopnea index and the degree of palatopharyngeal anteroposterior diameter collapse, palatopharyngeal collapse, glossopharyngeal right - and - left diameter collapse, glosso- pharyngeal collapse （ P 〈 0.05 ）. The degree of palatopharyngeal right - and - left diameter collapse and glossopharyngeal anteroposterior diameter collapse had no direct relation with AHI （P 〉 0.05 ）. Conclusion The adenoid - nasopharynx ratio and the pharyngeal collaps- ibility, which examined by EPMM were associated with increased rates of AHI. EPMM not only can reflect the severity of OSAHS,but also directly observe the content and location of pharyngeal collapsibility.