上呼吸道CT三维重建评价阻塞性睡眠呼吸暂停低通气综合征的临床应用

CT with 3D reconstruction of upper respiratory tract in obstructive sleep apnea hypopnea syndrome application

目的探讨上呼吸道cT三维重建评价阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的临床应用。方法OSAHS患者77例（轻度22例，中度22例，重度33例）和正常对照者22例，在CT下行上气道结构三维重建，测定软腭长度、厚度，软腭根部、悬雍垂、舌根、会厌距咽后壁距离与OSAHS病情程度关系。结果（1）OSAHS患者软腭长度[轻度组（41．77±9．14）mm，中度组（40．30±7．74）mm，重度组（40．64±9．64）mm]与正常对照组[（40．25±7．55）mm]比较，差异无统计学意义（P〉0．05）；OSAHS患者软腭厚度[轻度组（10．00±3．40）mm，中度组（10．31±2．53）mm]与正常对照组[（9．88±2．02）mm]比较，差异无统计学意义（P〉0．05），重度组[（11．49±2．62）mm]与正常对照组比较，差异有统计学意义（P〈0．05）。（2）平静吸气后屏气，OSAHS重度组患者会厌距咽后壁距离长于OSAHS中度组[（10．75±5．18）mmvs（7．61±3．57）mm]，差异有统计学意义（P〈0．05）；深吸气后屏气，OSAHS重度组患者悬雍垂距咽后壁距离短于正常对照组[（4．82±3．53）mmvs（7．10±4．64）mm]，差异有统计学意义（P〈0．05）。（3）OSAHS患者软腭厚度与BMI、呼吸暂停低通气指数（AHI）呈正相关（r=0．333，P〈0．01；r=0．226，P〈0．05），与最低血氧饱和度（LSpO2）、平均血氧饱和度（MSpO2）呈负相关（r=-0．283，P〈0．05；r=-0．400，P〈0．01）；平静吸气后及用力深吸气后屏气时软腭根部距咽后壁距离均与BMI呈负相关（r=-0．297，P〈0．01；r=-0．232，P〈0．05）；平静吸气后屏气时舌根距咽后壁距离与MSpO2呈负相关（r=-0．225，P〈0．05）；平静吸气后屏气时会厌距咽后壁距离与AHI呈正相关（r=0．277，P〈0．05），与MSpO2呈负相关（r=-0．289，P〈0．05）；呼气后深吸气悬雍垂距咽后壁距离与MSpO2呈正相关（r=0．260，P〈0．05）。结论OSAHS患者通过上气道CT三维重建与多导睡眠监测仪（PSG）指标相结合，对判断OSAHS病情的严重度、发病机制研究具有较大帮助，可作为治疗效果的判断指标之一，对临床具有指导意义。

Objective To investigate the relationship between the obstructive sleep apnea hypopnea syndrome （OSAHS） patient＇s structure of the upper airway and severity of OSAHS. Methods A total of 77 cases （22 cases of mild, moderate 22 cases, 33 cases of severe） of OSAHS patients and normal controls were 22 cases, in the three-dimensional structure of the downstream CT airway remodeling, measuring soft palate length, thickness, soft palate roots, uvula, tongue, epiglottis away from the posterior pharyngeal wall distance relationship with the severity of OSAHS. Results （1） In patients with OSAHS, the soft palate length [mild group （41.77 ±9. 14） mm, moderate group （40. 30 ±7. 74） mm and severe group （40. 64 ±9. 64）mm] and normal control group [ （40. 25 ± 7.55 ）mm ] compared, the difference was not statistically significant （ P 〉 0.05 ） ; the thickness of soft palate [ mild group （ 10.00 ± 3.40 ）mm, moderate group （ 10. 31 ±2. 53）mm] and normal control group [ （9. 88 ±2. 02）mm] compared, the difference was not sta- tistically significant （ P 〉 0. 05 ）, severe group [ （ 11.49 ±2. 62）mm ] and normal control group compared, the difference was statistically significant （ P 〈 0.05）. （2） in calm inspiratory breath hold and severe OS- AHS patients epiglottis from posterior pharyngeal wall distance was longer than the moderate OSAHS group [ （ 10. 75 ±5.18）mm vs （7.61 ±3.57）mm], the difference was statistically significant （ P 〈0. 05） ; after deep inspiratory breath hold, OSAHS patients in the severe group uvula from posterior pharyngeal wall dis- tance was shorter than in normal control group [ （4. 82 ±3.33）mm vs （7, 10 ±4. 64）mm], the difference was statistically significant （ P 〈 0. 05）. （3） In patients with OSAHS thickness of soft palate with body mass index （BMI） and apnea hypopnea index （AHI） were positively correlated （ r =0. 333, P 〈0.01; r = 0. 226, P 〈 0. 05 ）, and with lowest pulse oxygen saturation （ LSpO2 ） and mean pulse oxygen saturation （ MSpO2 ） were negative correlation （ r = - 0. 283, P 〈 0. 05 ; r = - 0. 400, P 〈 0. 01 ） ; in calm breathing and forced inspiratory breath hold, the soft palate roots from the posterior pharyngeal wall distance and BMI were negatively related （ r = - 0. 297, P 〈 0. 01 ; r = - 0. 232, P 〈 0. 05 ） ; in calm inspiratory breath hold root of the tongue from the posterior pharyngeal wall distance and MSpO2 was negatively related （ r = -0. 225, P 〈0.05） ; in calm inspiratory breath ho±d epiglottis from the posterior pharyngeal wall distance and AHI was positively correlated （ r = 0. 277, P 〈 0. 05 ）, and negatively related （ r = - 0. 289, P 〈 0. 05） with MSpO2 ; in forced inspiratory breath hold uvula from retropharyngeal wall distance and MSpO2 was positively correlated （ r = 0. 260, P 〈 0. 05）. Conclusions OSAHS patients through upper airway CT reconstruction with polysomnography （PSG） indicators combine to determine the severity of OSAHS disease pathogenesis studies, can be used as indicators to determine the therapeutic effect, have clinical signifi- cance.