本文選題：流體遷移 + 頭頸部磁共振成像　； 參考：《首都醫(yī)科大學(xué)》2013年碩士論文

【摘要】：阻塞性睡眠呼吸暫停（OSA）是一種常見的呼吸系統(tǒng)疾病�；颊咴谒郀顟B(tài)下呼吸道反復(fù)塌陷、阻塞造成的周期性缺氧會引起一系列嚴重后果，包括導(dǎo)致心血管系統(tǒng)的嚴重疾病。 近年國外研究發(fā)現(xiàn)，當由站或坐姿改變?yōu)榕P姿時，人體下部肢體的液體會向頭頸部遷移，引起呼吸道截面變窄，從而可能會加重睡眠狀態(tài)下上氣道阻塞的傾向。對于流體遷移這一問題，目前除了香港研究人員所做的一項研究，國內(nèi)尚未見到其它與此相關(guān)的研究工作發(fā)表。在國外研究中，通常利用抗休克褲對腿部施加壓力迫使流體向頸部遷移，以及使用咽聲反射儀測量上氣道截面積。這些方法存在一些明顯弱點。本研究的目的，是要探究體位改變導(dǎo)致的流體向頭頸部遷移對上氣道形態(tài)及呼吸功能的影響。為達此目的，我們提出將磁共振三維容積成像方法應(yīng)用到流體遷移研究中，并在研究方案中采用了一種自然流動的方式來實現(xiàn)流體自下肢向頭頸部的遷移。 在現(xiàn)有實驗中，研究人員觀察到了流體自下肢向頭頸部遷移時可以引起頸圍增加。但有一個沒被注意到，而又必須要理清的重要問題是，對于不同個體來說，流體遷移導(dǎo)致頸圍的增加是否總是伴隨著氣道截面積的顯著減小，或反過來，是否氣道截面的減小總是伴隨著頸圍的明顯增加。這個問題在臨床上至為重要，因為它涉及到是否可以根據(jù)患者體位改變后頸圍的變化來評估流體遷移對其氣道形態(tài)與呼吸功能影響的程度。對此我們提出了一個有關(guān)頸圍與氣道截面積變化不具有較強相關(guān)性的假設(shè)。 為驗證假設(shè)，我們使用三維擾相梯度回波序列（3D-SPGR）容積掃描方式對50例健康受試者（男性30名，女性20名）頭頸部自鼻腔頂部至喉結(jié)處進行四種狀態(tài)下的橫斷面磁共振成像，即平臥參考狀態(tài)，將雙腿抬起大于50o角并分別持續(xù)1分鐘和8分鐘之后的流體重新分布狀態(tài)，，以及回復(fù)到雙腿放下的平臥狀態(tài)。我們對圖像有關(guān)組織進行邊界分割，從選定橫斷面的圖像上提取四種狀態(tài)下上氣道截面和頸圍邊界的坐標，進而計算氣道橫截面積以及頸圍周長。通過對數(shù)據(jù)進行統(tǒng)計學(xué)分析，研究流體重新分布引起的上氣道截面積及頸圍尺度的變化。 實驗結(jié)果證實了我們的假設(shè)。數(shù)據(jù)表明，與通常想象的不同，流體遷移引起頸圍明顯增加時，并不一定伴隨著氣道截面積的顯著下降，反之亦然。除了獲得的重要結(jié)果，本研究提出的使用磁共振三維擾相梯度回波序列容積掃描來研究流體遷移對上氣道形態(tài)影響的方法也為探討體位改變對睡眠呼吸功能的影響提供了新的思路。
[Abstract]:Obstructive sleep apnea (OSA) is a common respiratory disease. During sleep, the respiratory tract collapses repeatedly, and the periodic hypoxia caused by blockage can lead to a series of serious consequences, including serious cardiovascular diseases. In recent years, it has been found that when the body changes from standing position or sitting position to lying position, the liquid of the lower limb of the human body will migrate to the head and neck, which may lead to the narrow section of the respiratory tract, which may aggravate the tendency of obstruction of the upper airway during sleep. As for the problem of fluid migration, no other related research work has been published in China except for one by Hong Kong researchers. In foreign studies, anti-shock pants are usually used to exert pressure on the legs to force the fluid to migrate to the neck, and to measure the cross section of the upper airway by using the pharyngeal acoustic reflectometer. There are some obvious weaknesses in these methods. The aim of this study was to investigate the effects of fluid migration to head and neck on upper airway morphology and respiratory function. In order to achieve this goal, we propose to apply Mr three-dimensional volumetric imaging to the study of fluid migration, and adopt a natural flow method to realize the migration of fluid from lower extremity to head and neck in the research scheme. In existing experiments, researchers have observed that fluid migration from the lower extremities to the head and neck can lead to increased neck circumference. But an important question that has not been noticed and has to be sorted out is whether, for different individuals, increased neck circumference due to fluid migration is always accompanied by a significant decrease in airway cross-sectional area, or vice versa. Whether the airway section decreases is always accompanied by a significant increase in the neck circumference. This issue is of clinical importance because it involves assessing the extent to which fluid migration affects airway morphology and respiratory function based on changes in the neck circumference of patients with postural changes. We propose a hypothesis that there is no strong correlation between neck circumference and airway cross-sectional area. To verify the hypothesis, we performed transversal magnetic resonance imaging of the head and neck of 50 healthy subjects (30 males and 20 females) from the top of the nasal cavity to the laryngeal node in four different states using three-dimensional disturbed phase gradient echo sequence 3D-SPGR. Namely the supine reference state, the fluid redistribution state after lifting the legs at a angle of more than 50 o for 1 minute and 8 minutes, respectively, and returning to the supine state where the legs are put down. We segment the relevant tissues of the image and extract the coordinates of upper airway section and neck border from the selected cross section images, and then calculate the cross section area and the circumference of the neck. The changes of upper airway cross-sectional area and neck circumference caused by fluid redistribution were studied by statistical analysis of the data. The experimental results confirm our hypothesis. The data show that fluid migration does not necessarily accompany a significant decrease in airway cross-sectional area when the neck circumference is significantly increased as a result of fluid migration, and vice versa. In addition to the important results, The method proposed in this study to study the effect of fluid migration on the morphology of upper airway by using three-dimensional disturbed phase gradient echo sequence volumetric scanning also provides a new way to study the effect of posture change on sleep respiratory function.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R766;R445.2

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