本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + 下頜前伸止鼾器��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]觀察輕、中度阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)患者戴用下頜前伸止鼾器(MASSD)前后上氣道形態(tài)及呼吸功能的變化,為明確下頜前伸止鼾器(MASSD)治療輕、中度OSAHS患者的治療機制、臨床療效提供參考和依據(jù)。[方法]選擇2015年2月-2017年1月于昆明醫(yī)科大學(xué)附屬延安醫(yī)院口腔科就診,經(jīng)多導(dǎo)睡眠監(jiān)測確診為輕、中度OSAHS患者30例,并排除其他可能導(dǎo)致氣道阻塞的疾病及解剖異常的患者。其中男性21例,女性9例,年齡25-59歲,平均年齡49歲;對患者戴用MASSD前后的上氣道行CBCT掃描,運用InVivo Dental軟件重建上氣道的三維形態(tài),確定氣道的測量平面及分區(qū),測量上氣道各截面的矢狀徑、冠狀徑、最小橫截面積及各段容積,并比較治療前后患者的呼吸紊亂指數(shù)(AHI)及最低血氧飽和度(LSaO2)等指標(biāo)的改變。數(shù)據(jù)采用SPSS21.0軟件包進行自身配對t檢驗。[結(jié)果]1.30例輕、中度OSAHS患者戴用下頜前伸止鼾器后主觀癥狀明顯改善,如無主觀憋醒情況,白天嗜睡癥狀明顯改善。陪睡家屬觀察患者夜間睡眠鼾聲大幅減輕甚至消失,呼吸暫停現(xiàn)象明顯減輕或消失,患者初戴止鼾器偶有不適,如晨起時個別牙的酸痛、口干等不適,長期戴用無明顯不良反應(yīng)。2.客觀指標(biāo)明顯改善:因鼾聲次數(shù)不服從正態(tài)分布,結(jié)果以P50 (P25, P75)表示,治療前后差異用秩和檢驗,P0.001,差異有顯著的統(tǒng)計學(xué)意義;未戴MASSD時 AHI 指數(shù)(20.61±5.19),戴入 MASSD 后 AHI 指數(shù)(10.86±4.31),差異有顯著的統(tǒng)計學(xué)意義(P0.001);未戴MASSD時最低血氧飽和度(LSaO2)(0.78±0.08),戴入MASSD后最低血氧飽和度(LSaO2) (0.92±0.03),差異有顯著的統(tǒng)計學(xué)意義(P0.001)。3.輕、中度OSAHS患者的軟腭下緣平面未戴MASSD時矢狀徑(7.01±1.43mm ),戴入MASSD后矢狀徑(14.78±1.36 mm ),差異有顯著的統(tǒng)計學(xué)意義(P0.001);軟腭下緣平面未戴MASSD時冠狀徑(20.46±1.24 mm),戴入MASSD后冠狀徑(28.35±1.85mm),差異有顯著的統(tǒng)計學(xué)意義(P0.001);會厭下緣平面未戴MASSD 時矢狀徑(9.58±0.95mm),戴入 MASSD 后矢狀徑(13.75±0.77mm),差異有顯著的統(tǒng)計學(xué)意義(P0.001);會厭下緣平面未戴MASSD時冠狀徑(19.86±2.06mm),戴入MASSD后冠狀徑(26.72±2.25mm),差異有顯著的統(tǒng)計學(xué)意義(P0.001);而硬聘平面未戴MASSD時矢狀徑(12.57±1.30mm),戴入MASSD后矢狀徑(12.01±1.04mm),差異無統(tǒng)計學(xué)意義(P0.05);硬聘平面未戴MASSD時冠狀徑(27.49±2.92 mm),戴入MASSD后冠狀徑(29.20±4.17mm),差異無統(tǒng)計學(xué)意義(P0.05)。表明患者在戴入MASSD后,軟腭下緣平面及會厭上緣平面的矢狀徑、冠狀徑明顯增大;而硬腭平面無明顯變化。4.輕、中度OSAHS患者的軟腭后區(qū)未戴MASSD時最小橫截面積(72.84±20.93 mm2),戴入MASSD后最小橫截面積(129.30±26.37mm2),差異有顯著的統(tǒng)計學(xué)意義(P0.001);舌后區(qū)未戴MASSD時最小橫截面積(139.54±35.13mm2),戴入MASSD后最小橫截面積(188.42±37.08mm2),差異有顯著的統(tǒng)計學(xué)意義(P0.001);會厭后區(qū)未戴MASSD時最小橫截面積(112.51±13.69mm2),戴入MASSD后最小橫截面積(220.81±22.04mm2),差異有顯著的統(tǒng)計學(xué)意義(P0.001);總氣道未戴MASSD時最小橫截面積(72.84±20.93 mm2),戴入MASSD后最小橫截面積(129.30±26.37mm2),差異有顯著的統(tǒng)計學(xué)意義(P0.001)。表明患者氣道軟腭后區(qū)、舌后區(qū)、會厭后區(qū)的最小橫截面積在戴入MASSD后,明顯增大,并發(fā)現(xiàn)最阻塞的部位于軟腭后區(qū)。5.輕、中度OSAHS患者的軟腭后區(qū)未戴MASSD時容積(4.99±0.60cc),戴入MASSD后容積(8.15±0.68cc),差異有顯著的統(tǒng)計學(xué)意義(P0.001);舌后區(qū)未戴MASSD時容積(4.12±0.45cc),戴入MASSD后容積(7.31±0.59cc),差異有顯著的統(tǒng)計學(xué)意義(P0.001);會厭后區(qū)未戴MASSD時容積(2.68±0.23cc),戴入MASSD后容積(3.82±0.52cc),差異有顯著的統(tǒng)計學(xué)意義(P0.001);氣道總體積未戴 MASSD 時容積(11.79±0.87cc),戴入 MASSD 后容積(19.31 ±1.11cc),差異有顯著的統(tǒng)計學(xué)意義(P0.001)。表明患者在戴入MASSD后,上氣道總?cè)莘e與軟聘后區(qū)、舌后區(qū)、會厭后區(qū)各段容積都有增大。[結(jié)論]1. MASSD治療輕、中度OSAHS患者具有較好的臨床療效;2.CBCT muller呼吸坐位掃描,戴用MASSD使輕、中度OSAHS患者上氣道的矢狀徑及冠狀徑同時增大;3.戴用MASSD使輕、中度OSAHS患者的氣道打開,增加上氣道通氣量,從而改善患者呼吸功能,為OSAHS的臨床診療工作提供理論指導(dǎo)。
[Abstract]:[Objective] to observe the changes in the upper airway morphology and respiratory function of patients with moderate obstructive sleep apnea hypopnea syndrome (OSAHS) before and after the use of mandibular protrusion snoring device (MASSD), and to provide a reference and basis for the treatment of mild and moderate OSAHS patients with mild, moderate and moderate snoring apparatus (MASSD) for the treatment of moderate and moderate OSAHS patients. [Methods] choose 2 2015. In the Department of Stomatology, Yanan Hospital Affiliated to Kunming Medical University, January, 30 cases of mild and moderate OSAHS were diagnosed by polysomnography and 30 patients with moderate OSAHS were excluded, and other patients with airway obstruction and anatomic abnormalities were excluded. Among them, there were 9 males, 9 women, 25-59 years old, and the average age of 49 years. CBCT scan, using the InVivo Dental software to reconstruct the three-dimensional shape of the upper airway, determine the measurement plane and partition of the airway, measure the sagittal diameter, the coronal diameter, the minimum cross section area and the volume of each section of the upper airway, and compare the changes in the index of the respiratory disturbance index (AHI) and the lowest oxygen saturation (LSaO2) before and after the treatment. According to the SPSS21.0 software package, the self matched t test was used. [results]1.30 cases were light, the subjective symptoms of moderate OSAHS patients were obviously improved after using the mandibular protrusion snoring device, such as no subjective waking up, the daytime sleepiness symptoms improved obviously. There were occasional discomfort in the early Dai snoring device, such as the pain of the teeth in the morning and the discomfort of the dry mouth, and the objective index of.2. without obvious adverse reaction. The snoring times did not obey the normal distribution, and the result was P50 (P25, P75), and the difference was statistically significant before and after the treatment, and the difference was not MA. The AHI index at SSD (20.61 + 5.19) and AHI index (10.86 + 4.31) after wearing MASSD were significant (P0.001); the lowest oxygen saturation (LSaO2) was (0.78 + 0.08) without MASSD, and the lowest oxygen saturation (LSaO2) (0.92 + 0.03) in MASSD (P0.001) was significant (P0.001).3. light, the soft palate of moderate OSAHS patients The sagittal diameter of the lower margin of MASSD (7.01 + 1.43mm) and the sagittal diameter (14.78 + 1.36 mm) after the insertion of MASSD had significant statistical significance (P0.001). The coronal diameter of the lower margin of the soft palate (20.46 + 1.24 mm) and the crown diameter of MASSD (28.35 + 1.85mm) had significant statistical significance (P0.001); the lower margin of the epiglottis was not used MA. The SSD sagittal diameter (9.58 + 0.95mm) and the sagittal diameter (13.75 + 0.77mm) after the insertion of MASSD had significant statistical significance (P0.001). The coronal diameter of the inferior epiglottis without MASSD (19.86 + 2.06mm) and the posterior crown diameter of MASSD (26.72 + 2.25mm) had significant statistical significance (P0.001), while the hard recruitment plane did not wear MASSD time (12.57 + 1). .30mm), there was no statistically significant difference in the sagittal diameter (12.01 + 1.04mm) after the insertion of MASSD, and the coronary diameter (27.49 + 2.92 mm) without MASSD in the hard recruitment plane, and the posterior crown diameter of MASSD (29.20 + 4.17mm). The difference was not statistically significant (P0.05). It was indicated that the coronal diameter of the lower margin of the soft palate and the epiglottis upper margin was obvious after the insertion of MASSD. The coronary diameter was obvious. There was no obvious change in the plane of the hard palate.4., and the minimum cross section area (72.84 + 20.93 mm2) in the soft palate posterior region of the moderate OSAHS patients, the minimum cross section area (129.30 + 26.37mm2) after the insertion of MASSD (129.30 + 26.37mm2), and the smallest cross-sectional area (139.54 + 35.13mm2) in the posterior region of the tongue (139.54 + 35.13mm2), and the most in MASSD. The small cross section area (188.42 + 37.08mm2) has significant statistical significance (P0.001); the minimum cross section area (112.51 + 13.69mm2) in the posterior epiglottis area without MASSD is (220.81 + 22.04mm2), and the difference has significant statistical significance (P0.001). The minimum cross section area (72.84 + 20.93 mm2) when the total airway is not worn and MASSD, is put into M. The minimum cross section area (129.30 + 26.37mm2) after ASSD was statistically significant (P0.001). It showed that the minimum cross section area in the posterior region of the soft palate of the airway, the posterior region of the tongue, and the posterior region of the epiglottis obviously increased after the insertion of MASSD, and found that the most obstructed part in the posterior region of the soft palate was.5. light, and the volume of the posterior region of the soft palate in the moderate OSAHS patients had no MASSD volume (4.99 +). 0.60cc), the volume (8.15 + 0.68cc) after the entry of MASSD had significant statistical significance (P0.001), the volume of the posterior region of the tongue was not MASSD (4.12 + 0.45cc), and the volume (7.31 + 0.59cc) after the insertion of MASSD (7.31 + 0.59cc). The volume of the posterior region of the epiglottis was (2.68 + 0.23cc), and the volume (3.82 +) after being put into MASSD (3.82 +). Significant statistical significance (P0.001); the volume of the total airway volume was not MASSD (11.79 + 0.87cc) and the volume (19.31 + 1.11cc) after the entry of MASSD. The difference was statistically significant (P0.001). The total volume of the upper airway and the posterior region of the tongue, the posterior region of the tongue, and the posterior region of the epiglottis were increased. [conclusion]1. MASSD treatment). Mild treatment, moderate OSAHS patients have good clinical efficacy; 2.CBCT Muller breathing seat scan, wear MASSD to reduce the upper airway and coronary diameter of mild and moderate OSAHS patients; 3. wear MASSD to open the airway of mild, moderate OSAHS patients, increase the upper airway ventilation, and thus improve the respiratory function of patients, for the clinical diagnosis and treatment of OSAHS. Work provides theoretical guidance.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R766

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