记忆合金覆膜支架治疗小香猪阻塞性睡眠呼吸暂停低通气综合征的研究

A study of nickel-titanium memory alloy covered stents in the treatment of obstructive sleep apnea-hypopnea syndrome in mini musk swine model

目的:探索记忆合金覆膜支架(NTMACS)植入咽部肌肉治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法:用高脂高糖饮食和颏舌肌注射A型肉毒杆菌毒素建立3只小香猪OSAHS模型。多导睡眠监测仪(PSG)验证后,在颏舌骨肌和舌骨舌肌间隙手术植入片状NTMACS,术后观察动物吞咽和睡眠,术后3个月再行PSG检测,对比快速动眼阶段睡眠时间(REM)、呼吸暂停低通气指数(AHI)、最长呼吸暂停时间(LA)、最低血氧饱和度(LSa O_2)等指标。术前术后拍摄呼气末期的三维CT获取猪颌面部复合组织数字化信息,进行软硬组织的三维重建及气道分析。结果:迷你猪OSAHS模型[AHI=(38±3)次/h]构建成功,植入NTMACS后实验猪的进食、睡眠和体重等无明显改变,嗜睡状况明显好转,术后3月PSG检测AHI下降至(18±2)次/h,其他睡眠指标也显著改善。术前术后数字化分析可见植入支架位置稳定,气道分析可见实验猪的气道容积显著增大。对支架周围组织行HE染色发现NTMACS的组织相容性良好。结论:NTMACS可能对OSAHS治疗安全有效。

Objective:To study the effects of nickel-titanium memory alloy covered stents(NTMACS)in the treatment of obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods:The OSAHS model of 3 mini musk swines was built by high-fat and high-carbohydrate diet with BTX-A injection in the genioglossus.Polysomnography(PSG)was used to testify the OSAHS model and the treatment effects.NTMACS was implanted into the compartment between geniohyoideus and genioglossus.The swallowing function and sleep was observed,the treatment effects were evaluated at the 3rd month post-operatively with PSG.The rapid eye movement stage(REM)duration,the apnea and hypopnea index(AHI),the longest apnea time(LA),the lowest oxygen saturation(LSaO 2)were recorded and compared.3D-CT examination was performed at the end of expiratory stage.The 3D image reconstruction of the airway,the soft tissue and the bones was formed and the airway alteration were analyzed.Results:The OSAHS mini musk swine model was established(AHI=38±3 times/hour).No abnormality of swallowing function and the sleeping condition was detected post-operatively.The PSG also showed that the AHI dropped to 18±2 times/hour and all other PSG indexes were improved.The airway analysis showed that the space of the upper airway was significantly expanded.HE staining of the tissues around NTMACS showed good biocompatibility of the covered stents.Conclusion:NTMACS may be safe and effective in the treatment of OSAHS.