CT辅以Muller检查法对OSAHS的诊断价值及锻炼咽腔与颏舌肌治疗OSAHS疗效分析

The value of CT combined with Muller examination in the diagnosis of OSAHS and the therapeutic effect of pharyngeal and genioglossus on OSAHS

目的探讨CT辅以Muller检查法在阻塞性睡眠呼吸暂停综合征(OSAHS)中的诊断价值,观察锻炼咽腔与颏舌肌法治疗解剖狭窄不明显的OSAHS的临床疗效。方法选取我院在2016年5月~2017年5月收治的OSAHS患者73例,设为观察组,另选取同期在我院健康体检人群60例,设为对照组。对全部受试者进行多层螺旋CT扫描及气道三维重建技术检查,比较两组患者上气道各测量参数。另选取观察组中气道狭窄不明显的患者按照随机数字表法分为A亚组和B亚组,A亚组给予咽腔与颏舌肌功能锻炼治疗,B亚组不行任何治疗,观察两亚组患者埃普沃思嗜睡量表(Epworth)、匹兹堡睡眠指数及最长低通气时间和夜间平均血氧饱和度。结果(1)观察组腭后区、舌后区气道矢状径、横径明显小于对照组,咽侧壁和后壁厚度明显大于对照组,差异具有统计学意义(P<0.05);观察组舌后区、腭后区、喉咽部各气道平面狭窄度明显大于对照组,差异具有统计学意义(P<0.05);观察组软腭长度和厚度均明显大于对照组,差异具有统计学意义(P<0.05)。(2)治疗后A亚组Epworth、匹兹堡睡眠指数评分明显低于B亚组,差异具有统计学意义(P<0.05);A亚组最长低通气时间明显短于B亚组,夜间平均血氧饱和度高于B亚组,差异具有统计学意义(P<0.05)。结论多层螺旋CT和气道三维重建技术可有效评估OSAHS患者的咽壁软组织和上气道狭窄情况;对于气道狭窄不明显、上气道扩张肌功能下降、咽侧壁顺应性高者进行咽腔与颏舌肌功能锻炼治疗可纠正夜间低氧血症,提高患者睡眠质量,值得临床推广。

Objective To investigate the diagnostic value of Muller＇s method combined with Muller＇s test in obstructive sleep apnea hypopnea syndrome（OSAHS） and to observe the clinical effect of pharyngeal and genioglossus manipulation on OSAHS with no apparent stenosis. Methods Seventy-three OSAHS patients admitted to our hospital from May 2016 to May 2017 were selected as the observation group and another 60 healthy people in our hospital were selected as the control group. All the subjects were enrolled Multi-slice spiral CT scan and three-dimensional reconstruction of airway technology to check and compare the two groups of patients with upper airway measurement parameters; the other se- lected observation group without obvious airway stenosis patients according to random number table were divided into subgroup A and subgroup B, subgroup A was given pharyngeal and genioglossal muscle functional exercise treatment, subgroup B without any treatment, the Epworth sleepiness scale （Epworth）, Pittsburgh sleep index and the longest hypo- baric time and night average oxygen saturation of two subgroups were compared. Results （1）The sagittal diameter and transverse diameter of the airway in the palatal and lingual posterior region of the observation group was significantly smaller than that of the control group. The thickness of the pharyngeal wall and posterior wall was significantly larger than that of the control group （P〈O.05）. The stenosis of each airway in the posterior lingual region, palatal region and hypopharynx of the observation group was significantly larger than that of the control group（P〈0.05）. The length and thickness of the soft palate in the observation group were significantly larger than those in the control group, the dif- ference was statistically significant（P〈0.05）. （2）The score of Epworth and Pittsburgh sleep index in subgroup A was significantly lower than that in subgroup B after treatment, the difference was statistically significant （P〈0.05）. The longest hypobaric duration in subgroup A was significantly shorter than that in subgroup B, and the average night oxygen satu- ration was higher than that in subgroup B（P〈0.05）. Conclusion MSCT and airway three-dimensional reconstruction can effectively evaluate the pharyngeal soft tissue and airway stenosis in patients with OSA1AS. For airway stenosis is not obvious, the function of upper airway dilatation muscle decreased, the compliance of pharyngeal wall is high, the pharyngeal and genioglossus functional exercise therapy can correct nighttime hypoxemia, improve the quality of sleep in patients, it is worth clinical promotion.