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目的:探讨呼吸面罩内压力变化对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者和正常人上呼吸道形态的影响。方法:采用16排螺旋CT自鼻咽顶部到声门之间的区域进行连续扫描,应用图像工作站测量软腭后区、悬雍垂区、舌后区和会厌后区的气道横截面积、左右径和前后径。对35例正常对照者和46例OSAHS患者分别行面罩内压力为0kPa和0.784kPa状态下的CT扫描,比较正常对照者和OSAHS患者间在各种条件下上呼吸道各测量指标的差异。结果:在面罩内压力相同的条件下,OSAHS患者上呼吸道CT测量的多数指标明显小于对照组(P<0.05或P<0.01);对照组和OSAHS患者上呼吸道多数测量指标在0.784kPa正压条件下较0kPa时有明显增加(P<0.05或P<0.01),其中对照组的增加幅度明显大于OSAHS组(P<0.05或P<0.01);以35例对照者确定面罩内压力由0kPa增加到0.784kPa时上呼吸道软腭后区、悬雍垂区、舌后区和会厌后区横截面积增加的最小正常值为标准,将46例OSAHS患者分为上气道正常扩张的17例和扩张度低于正常的29例,在0kPa下这2组患者上呼吸道CT测量指标差异无统计学意义(P>0.05);而在0.784kPa条件下,前者的上呼吸道多项测量指标均大于后者(P<0.05或P<0.01)。结论:面罩内压力的增加可以在不同程度上导致OSAHS患者和对照者上呼吸道的扩张,其中OSAHS患者的扩张程度明显小于对照者;OSAHS患者上呼吸道扩张程度较小的原因与其上呼吸道存在解剖性狭窄和咽壁本身的可扩张性减弱有关。
Objective: To investigate the effects of pressure changes in respiratory mask on upper respiratory tract in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and normal subjects. Methods: The 16-slice spiral CT was used to continuously scan the area between the top of the nasopharynx and the glottis. The image workstation was used to measure the airway cross-sectional area in the posterior soft palate, uvula area, posterior lingual area and epigynous area Trail and anteroposterior diameter. Thirty-five normal controls and 46 OSAHS patients underwent a CT scan at pressures of 0 kPa and 0.784 kPa, respectively. The differences of the upper respiratory tract parameters between the normal control and OSAHS patients were compared. Results: Most of the indexes of upper airway CT measured by the OSAHS patients were significantly lower than those of the control group (P <0.05 or P <0.01) under the same pressure in the mask. Most of the upper respiratory tract indexes in the control group and the OSAHS patients were positive under 0.784kPa positive pressure (P <0.05 or P <0.01), and the increase in the control group was significantly greater than that in the OSAHS group (P <0.05 or P <0.01). The pressure in the mask increased from 0 kPa to 0.784kPa upper respiratory tract soft palate posterior area, uvula area, posterior lingual and ephemeroptera after the cross-sectional area of the smallest normal increase as the standard 46 cases of OSAHS patients were divided into upper airway normal expansion in 17 cases and expansion There were no significant differences in the upper respiratory tract CT parameters between the two groups at 0kPa (P> 0.05). However, under the condition of 0.784kPa, the indices of the upper respiratory tract of the former were higher than those of the latter P <0.05 or P <0.01). CONCLUSIONS: The increase of pressure in the mask can cause OSAHS patients and controls to expand to varying degrees in the upper respiratory tract, OSAHS patients with the expansion was significantly less than the control group; OSAHS patients with upper respiratory tract expansion of the smaller extent of its upper airway anatomy Stenosis and pharyngeal wall itself weakening related to expansibility.