论文部分内容阅读
目的:研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者清醒和自然睡眠2种状态下软腭的运动情况和引起阻塞的原因。方法:2007-05-2007-12到同济大学附属第十人民医院耳鼻咽喉科就诊并经睡眠问卷调查表、临床体检及多导睡眠监测仪证实的OSAHS患者16例,分别在清醒和自然睡眠状态下进行上气道正中矢状位动态磁共振成像(Cine-MRI),要求MRI检查前夜保持清醒。将2种状态下Cine-MRI正中矢状位成像导入电脑,测量软腭的形态变化、前后摆动角度和长度。采用配对t检验统计学分析清醒与自然睡眠状态下各径线值和角度差异。结果:清醒状态下软腭的形态有正常形、镰刀形、鱼钩形和倒S形,主要以向后飘动方式和前后径增宽引起阻塞(腭悬距P>0.05,腭腹夹角P<0.05,腭背夹角P<0.01,腹背夹角差P<0.01),阻塞层面主要在软腭后区。自然睡眠状态下软腭的形态除有清醒状态下的形态外,更有感叹号形、竖条形等,主要以向下增长及前后径增宽的方式引起阻塞(腭悬距P<0.01,腭腹夹角P>0.05,腭背夹角P>0.05,腹背夹角差P<0.01),阻塞层面主要在舌后区。结论:OSAHS患者自然睡眠状态下较清醒状态下软腭的形态变化更多样,软腭引起上气道阻塞的层面更深,阻塞主要原因不同,清醒状态下不能代表睡眠状态下的软腭变化。
OBJECTIVE: To investigate the movement of the soft palate and the causes of obstruction in two states of awake and spontaneous sleep in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: From May 2007 to December 2007, 16 patients with OSAHS confirmed by sleep examination questionnaire, clinical examination and polysomnography were enrolled in Department of Otorhinolaryngology, Tenth People’s Hospital affiliated to Tongji University. The patients were divided into conscious and spontaneous sleep states Under the upper airway midsagittal dynamic magnetic resonance imaging (Cine-MRI), requiring MRI to stay awake on the eve of the night. The Cine-MRI median sagittal images were imported into the computer in two different states to measure the morphological changes of the soft palate, the anteroposterior swing angle and the length. Paired t-test was used to analyze the difference between the diameter and angle of each diameter under awake and natural sleep conditions. Results: The shape of soft palate in awake state was normal, sickle-shaped, fish-hooked and inverted S-shaped. The obstruction was mainly caused by backward waving and anteroposterior diameter broadening (palatal spacing P> 0.05, palatal angle P < 0.05, the angle between the palate and back was less than 0.01, the difference between the angle of back and abdomen was P <0.01). The occlusion level was mainly in the posterior region of the soft palate. In addition to awake state, the shape of soft palate under natural sleep is more exclamation point shape, vertical bar shape and the like, which causes obstruction mainly in the way of downward growth and anteroposterior diameter widening (palatal suspension distance P <0.01, palatal Angle P> 0.05, angle of palatal p> 0.05, angle difference of abdominal and abdomen P <0.01). The occlusion level was mainly in the posterior lingual region. Conclusion: The morphological changes of soft palate in OSAHS patients under awake condition are more diverse. The level of upper airway obstruction caused by soft palate is deeper and the main reason for the obstruction is different. The awake state can not represent the change of soft palate in sleep state.