本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + 磁共振�。� 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：阻塞性睡眠呼吸暫停低通氣綜合癥(obstructive sleep apnea hypopnea syndrome,OSAHS)是指睡眠時(shí)上氣道塌陷阻塞引起的睡眠呼吸暫停和通氣不足、伴有打鼾、睡眠結(jié)構(gòu)紊亂,頻繁發(fā)生血氧飽和度下降、白天嗜睡等病癥,目前該病主要以持續(xù)氣道正壓(CPAP)以及手術(shù)治療為主,手術(shù)方法主要是改良的懸雍垂腭咽成形術(shù)(uvulopalatopharyngoplasty,UPPP)為主,未經(jīng)篩選的OSAH S手術(shù)成功率僅可達(dá)到50%左右,因此,阻塞部位的確定對(duì)于手術(shù)成功率及手術(shù)預(yù)后起到至關(guān)重要的作用。本研究中應(yīng)用動(dòng)態(tài)MRI對(duì)OSAHS患者的上氣道進(jìn)行清醒及睡眠狀態(tài)下上氣道掃描,對(duì)掃描所獲得的相關(guān)數(shù)據(jù)與多導(dǎo)睡眠監(jiān)測(cè)指數(shù)進(jìn)行相關(guān)性分析,同時(shí)將纖維喉鏡下Müller試驗(yàn)與MRI檢查結(jié)果進(jìn)行對(duì)比,進(jìn)一步探索這兩種OSAHS患者術(shù)前檢查的優(yōu)勢(shì)及不足。一阻塞性睡眠呼吸暫停低通氣綜合征患者的軟腭后區(qū)及舌骨位置的睡眠動(dòng)態(tài)MRI研究目的通過對(duì)來院就診的阻塞性睡眠呼吸暫停低通氣綜合征患者行術(shù)前睡眠及清醒狀態(tài)下的上氣道動(dòng)態(tài)MRI檢查,確定其上氣道阻塞部位,為手術(shù)方案的制定提供依據(jù)。同時(shí),將患者軟腭后區(qū)徑線數(shù)據(jù)、舌骨的位置高低與多導(dǎo)睡眠監(jiān)測(cè)的數(shù)據(jù)之間加以分析,找出之間的聯(lián)系并進(jìn)一步探討疾病的發(fā)病機(jī)制。方法前瞻性分析了于2015年2月~2015年10月就診于鄭州大學(xué)第一附屬醫(yī)院咽喉頭頸外科的25例阻塞性睡眠呼吸暫停低通氣綜合征患者的臨床資料,入院后于我科行多導(dǎo)睡眠監(jiān)測(cè)以明確診斷,確診的患者分別于清醒及睡眠狀態(tài)下行上氣道的動(dòng)態(tài)MRI掃描,明確患者睡眠狀態(tài)下的上氣道阻塞部位,并將掃描獲得的軟腭后區(qū)徑線變化幅度、舌骨的垂直移動(dòng)距離與多導(dǎo)睡眠監(jiān)測(cè)所獲得的部分參數(shù)進(jìn)行相關(guān)性研究,其中6名患者因MRI檢查過程中無法自然入睡未被納入研究。結(jié)果1.軟腭后區(qū)相關(guān)測(cè)量指標(biāo)與AHI的相關(guān)性分析結(jié)果19例被納入研究的患者中,多重部位阻塞者6例,單純軟腭后阻塞者13例,患者睡眠狀態(tài)下軟腭后最小前后徑與血氧飽和度低于90%時(shí)間占總檢測(cè)時(shí)間百分比(CT90%)具有相關(guān)性(r=0.474,p0.05),軟腭后最小左右徑與CT90%(r=0.510,p0.05)以及最低血氧飽和度(LSa O2)(r=0.546,p0.01)具有相關(guān)性,前后徑變化幅度與睡眠呼吸暫停低通氣指數(shù)(AHI)(r=0.622,p0.01)、CT90%(r=0.581,p0.01)及最低血氧飽和度(LSa O2)(r=-0.496,p0.05)均具有相關(guān)性,左右徑變化幅度與AHI(r=0.476,p0.05)、CT90%(r=0.839,p0.05)及LSa O2(r=-0.777,p0.01)均具有相關(guān)性。2.舌骨位置與AHI的相關(guān)性分析結(jié)果睡眠狀態(tài)下患者舌骨垂直活動(dòng)度大于清醒狀態(tài)下舌骨的垂直活動(dòng)度。本次研究數(shù)據(jù)表明,舌骨最低位置與術(shù)前AHI呈正相關(guān)(r=0.473,p0.05),舌骨垂直活動(dòng)度與最低血氧飽和度成負(fù)相關(guān)(r=-0.437,p0.05),舌骨垂直活動(dòng)度與CT90%成正相關(guān)(r=0.665,p0.01)。結(jié)論睡眠狀態(tài)下上氣道動(dòng)態(tài)MRI可如實(shí)反映阻塞性睡眠呼吸暫停低通氣綜合征患者的上氣道塌陷情況,軟腭后徑線及舌骨位置可能影響疾病嚴(yán)重程度。二應(yīng)用動(dòng)態(tài)磁共振及纖維喉鏡對(duì)阻塞性睡眠呼吸暫停低通氣綜合癥患者的術(shù)前檢查對(duì)比研究目的應(yīng)用動(dòng)態(tài)磁共振及纖維喉鏡下Müller試驗(yàn)檢查對(duì)阻塞性睡眠呼吸暫停低通氣綜合征患者進(jìn)行術(shù)前上氣道阻塞部位的定位,對(duì)比兩者的檢查效果,探討其臨床應(yīng)用價(jià)值。方法選取2015年10月-2016年4月到鄭州大學(xué)第一附屬醫(yī)院咽喉頭頸外科就診并經(jīng)多導(dǎo)睡眠監(jiān)測(cè)(PSG)及專科檢查確診的阻塞性睡眠呼吸暫停低通氣綜合癥患者共計(jì)28例,分別于術(shù)前行纖維喉鏡下Müller試驗(yàn)檢查和睡眠及清醒狀態(tài)下動(dòng)態(tài)磁共振檢查,檢查軟腭區(qū)、舌后區(qū)及會(huì)厭區(qū)狹窄或阻塞發(fā)生情況,其中6例患者因磁共振檢查過程中無法自然入睡未被納入研究。結(jié)果電影磁共振與纖維喉鏡下Müller試驗(yàn)對(duì)于軟腭區(qū)阻塞的定位(22例對(duì)22例)具有完全的一致性,而對(duì)于舌后區(qū)(13例對(duì)6例)、會(huì)厭區(qū)(4例對(duì)2例)及多部位同時(shí)阻塞的定位(13例對(duì)6例),二者一致性一般。結(jié)論對(duì)多部位阻塞的中重度OSAHS患者,術(shù)前同時(shí)應(yīng)用睡眠動(dòng)態(tài)磁共振及纖維喉鏡檢查能夠更好明確阻塞部位,結(jié)合我們的檢查結(jié)果所示,對(duì)于多部位阻塞的OSAHS患者,睡眠動(dòng)態(tài)磁共振的檢查結(jié)果明顯優(yōu)于纖維喉鏡。
[Abstract]:Obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea hypopnea syndrome, OSAHS) refers to sleep apnea and hypoventilation caused by upper airway collapse obstruction during sleep, accompanied by snoring, disorder of sleep structure, frequent descent of oxygen saturation and daytime sleepiness, and the disease is currently mainly due to continuous airway correction. Pressure (CPAP) and surgical treatment mainly, the main operation method is the modified uvulopalatopharyngoplasty (uvulopalatopharyngoplasty, UPPP), and the success rate of the unscreened OSAH S operation is only about 50%. Therefore, the determination of the blocking site plays a vital role in the success rate of the operation and the prognosis of the operation. The upper airway of OSAHS patients was sober and the upper airway scan was scanned in the sleep state. The correlation data obtained by the scan were correlated with the polysomnography index, and the M u ller test under the fiberoptic laryngoscope and the results of MRI examination were compared to further explore the advantages and disadvantages of these two OSAHS patients before operation examination. The dynamic MRI study of the posterior area of the soft palate and the position of the hyoid in the patients with obstructive sleep apnea hypopnea syndrome objective to determine the upper airway obstruction in the patients with obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea hypopnea syndrome) in patients with obstructive sleep apnea hypopnea syndrome, and to determine the location of the upper airway obstruction. At the same time, the data of the posterior area line of the soft palate, the position of the hyoid bone and the data of polysomnography were analyzed to find the connection and further explore the pathogenesis of the disease. Methods to look forward to the pharynx and neck surgery of the First Affiliated Hospital of Zhengzhou University in October ~2015 February 2015. The clinical data of 25 patients with obstructive sleep apnea hypopnea syndrome were admitted to our department after admission to the Department of polysomnography to make a clear diagnosis. The patients were diagnosed with dynamic MRI scan on the upper airway in sober and sleep state. The upper airway obstruction position in the patient's sleep state was clearly defined and the posterior area of the soft palate was scanned. The range of variation, the vertical distance of the hyoid bone and the partial parameters obtained by the polysomnography, 6 of the patients were not included in the study during the MRI examination. Results 1. the correlation analysis of the relative measurements of the posterior palate area and the correlation of the AHI was found in 19 patients who were included in the study. In 6 patients and 13 patients with simple soft palate obstruction, the minimum posterior diameter of the soft palate and the percentage of oxygen saturation less than 90% of the total detection time (CT90%) were related (r=0.474, P0.05), and the smallest diameter after the soft palate was correlated with CT90% (r=0.510, P0.05) and the lowest oxygen saturation (r=0.546, P0.01). The change amplitude of the anterior and posterior diameter was correlated with the sleep apnea hypopnea index (AHI) (r=0.622, P0.01), CT90% (r=0.581, P0.01) and the lowest oxygen saturation (r=-0.496, P0.05). The results showed that the minimum position of hyoid bone was positively correlated with preoperative AHI (r=0.473, P0.05), and the vertical degree of hyoid activity was negatively correlated with the lowest oxygen saturation (r=-0.437, P0.05), and the vertical activity of hyoid bone and CT90% were positive. Correlation (r=0.665, P0.01). Conclusion the upper airway dynamic MRI under sleep can accurately reflect the upper airway collapse in patients with obstructive sleep apnea hypopnea syndrome. The soft palate posterior diameter and the hyoid position may affect the severity of the disease. Two the application of dynamic magnetic resonance and fiberoptic laryngoscope to obstructive sleep apnea hypopnea syndrome The preoperative examination and comparison of the patients with M u ller test under the dynamic magnetic resonance and fiberoptic laryngoscopy for the location of the upper airway obstruction in the patients with obstructive sleep apnea hypopnea syndrome, compare the results of the two, and discuss the value of its clinical application value. Methods selected from April to Zhengzhou in October 2015, to Zhengzhou. A total of 28 patients with obstructive sleep apnea hypopnea syndrome diagnosed in the First Affiliated Hospital of the First Affiliated Hospital of the University were diagnosed with polysomnography (PSG) and specialized examination. The M u ller test under fiberoptic laryngoscope and dynamic magnetic resonance examination under sleep and awake state were performed before the operation. The stenosis or obstruction occurred in the region, of which 6 patients were unable to fall asleep naturally during magnetic resonance examination. Results the film magnetic resonance and the M u ller test under the fiberoptic laryngoscope were completely consistent for the location of the soft palate block (22 cases of 22 cases), but for the posterior region of the tongue (6 cases in 13 cases), the epiglottis area (4 cases 2 cases) and multiple parts. Concomitant occlusion (13 cases of 6 cases) and the consistency of the two were common. Conclusions for patients with moderate to severe OSAHS with multiple site obstruction, preoperative sleep dynamic magnetic resonance and fiberoptic laryngoscopy can better identify the blocking sites. Combined with our findings, the dynamic MRI of sleep dynamic MRI for multiple obstructive OSAHS patients is examined. The results were obviously superior to that of fibrous laryngoscopy.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R766
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本文編號(hào)：2089025