本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + 上氣道　； 參考：《山東大學》2010年碩士論文

【摘要】： 研究目的 比較阻塞型睡眠呼吸暫停低通氣綜合征(OSAHS)患者戴用可調型下頜類前移矯治器前后上氣道容積的變化,并對有關因素,如：體塊指數(shù)(BMI)、下頜平面角(FH-MP)、AHI改變量(AAHI)等進行相關性分析,探索下頜前移類矯治器治療OSAHS的機制。 研究對象和方法 選取9名經(jīng)主觀癥狀、EDS評價和PSG監(jiān)測,診斷為輕中度OSAHS的患者。根據(jù)患者的PSG監(jiān)測結果、患者睡眠狀況和EDS得分,制作可調型拉桿式下頜前移類矯治器并調整至最佳位置�；颊叽饔孟骂M前移類矯治器3個月后,再進行PSG監(jiān)測和EDS評分,并分別于不戴矯治器和戴用矯治器時進行CT拍攝。 應用CT三維重建軟件VGstudio MAXv1.2進行上氣道三維重建,測量戴用下頜前移類矯治器前后腭咽、舌咽、喉咽各段的容積和上氣道容積(腭咽、舌咽、喉咽容積之和)。比較戴用下頜前移類矯治器前后各段氣道的容積變化,并用統(tǒng)計學方法對與容積變化可能有關的相關因素,如體塊指數(shù)(BMI)、下頜平面角(FH-MP)、治療前AHI(AHI前)、治療前后AHI變化量(△AHI)進行相關性分析。 結果 1.9名患者中,8名患者戴用下頜前移類矯治器后顯效(呼吸暫停、打鼾明顯減輕,AHI20和降低50%)；1名患者戴用下頜前移類矯治器治療無效(AHI降低25%)。本實驗中下頜前移類矯治器的治療有效率為88.89%。 2.戴用下頜前移類口腔矯治器后,上氣道腭咽容積增加明顯(從2340.22±306.26 mm3增加到3277.67±498.10 mm3,增加了41.21±17.25%,p0.001)；舌咽容積增加明顯(從3163.89±313.78 mm3增加到4538.00±548.37 mm3,增加了43.51±17.07%,p0.001)；喉咽容積增加較少(3321.33±286.81 mm3增加到3629.33±335.96 mm3,增加了9.35±8.51%,p0.05)；上氣道總容積增加明顯(從8864.67±865.54mm3增加到11670.33±1423.05mm3,增加了32.36±14.58%P0.001)。 3.上氣道容積的改變(△volume％)與患者戴用矯治器前后AHI的改變量(AAHI)有明顯相關性(r=0.71,P=0.03)。 4.上氣道容積的改變(△volume％)與戴用矯治器前AHI(AHI前)沒有明顯相關性(r=0.56,P=0.12)。 5.上氣道容積的改變(△volume％)與患者BMI呈負相關(r=-0.70,P=0.03),表明患者體塊指數(shù)越大,上氣道容積增加越少。 6.上氣道容積的改變(△volume％)與患者下頜平面角(FH-MP)無明顯相關性(r=-0.43,P=0.25)。 結論 1.下頜前移類矯治器可改變氣道大小,使氣道容積明顯增大,尤其是腭咽和舌咽段容積顯著增大,是治療輕、中度OSAHS的一種有效方法。 2.下頜前移引起的上氣道容積的改變與AHI改變量呈正相關,即上氣道容積增加越多,患者呼吸狀況改善越多；而上氣道容積的改變與患者體塊指數(shù)呈負相關性,即體塊指數(shù)越大,上氣道容積改變越小 3.本實驗研究結果不能證明下頜前移引起的上氣道容積的改變與治療前AHI、下頜平面角(FH-MP)沒有顯著相關性,即上氣道容積的改變與治療前OSAHS的嚴重程度、患者的下頜平面角大小沒有顯著關系。
[Abstract]:research objective
The changes of upper airway volume in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) with adjustable mandibular forward shift appliance were compared, and related factors, such as body mass index (BMI), mandibular plane angle (FH-MP) and AHI change (AAHI), were analyzed to explore the mechanism of mandibular anterior shift appliance in the treatment of OSAHS.
Research objects and methods
9 patients with mild and moderate OSAHS were selected by subjective symptoms, EDS evaluation and PSG monitoring. According to the PSG monitoring results of the patients, the patients' sleep status and EDS score were made and the adjustable pull rod type mandibular forward orthodontic appliance was made and adjusted to the best position. After 3 months of the mandibular anterior shift orthodontic appliance, the patients were followed by PSG monitoring and EDS score. CT was taken without wearing appliances or appliances.
CT 3D reconstruction software VGstudio MAXv1.2 was used to reconstruct the upper airway, and the volume and volume of the upper airway (palatopharynx, glossopharynx and laryngopharynx volume) were measured before and after the mandibular forward shift appliance, and the volume changes of the airway in the anterior and posterior segments of the mandibular anterior shift appliance were compared with the statistical method. Relative factors related to volume change, such as body mass index (BMI), mandibular plane angle (FH-MP), pre treatment AHI (AHI), and AHI changes before and after treatment (delta AHI) were analyzed.
Result
Of the 1.9 patients, 8 patients were displayed after the mandibular forward orthodontic appliance (apnea, snoring, AHI20 and 50%), and 1 patients were treated with mandibular forward orthodontic appliance (AHI 25%). The effect of the mandibular forward orthodontic therapy was 88.89%. in this experiment.
2. after the mandibular forward orthodontic appliance, the upper airway palatopharyngeal volume increased significantly (from 2340.22 + 306.26 mm3 to 3277.67 + 498.10 mm3, increased 41.21 + 17.25%, p0.001), the glossopharyngeal volume increased significantly (from 3163.89 + 313.78 mm3 to 4538 + 548.37 mm3, plus 43.51 + 17.07%, p0.001), and the volume of laryngopharynx increased less. The increase of 33 + 286.81 mm3 to 3629.33 + 335.96 mm3, increased by 9.35 + 8.51%, P0.05), the increase of total volume of upper airway (from 8864.67 + 865.54mm3 to 11670.33 + 1423.05mm3, increased by 32.36 + 14.58%P0.001).
3. the change of upper airway volume (delta volume%) was significantly correlated with the amount of AHI (AAHI) before and after wearing the appliance (r=0.71, P=0.03).
4. there was no significant correlation between the volume of upper airway (delta volume%) and AHI before wearing the appliance (AHI before) (r=0.56, P=0.12).
5. the change of upper airway volume (delta volume%) was negatively correlated with BMI (r=-0.70, P=0.03), indicating that the larger the body mass index, the smaller the upper airway volume.
6. there was no significant correlation between the change of upper airway volume (delta volume%) and the mandibular plane angle (FH-MP) of the patients (r=-0.43, P=0.25).
conclusion
The 1. mandibular forward moving appliance can change the size of the airway and increase the volume of the airway obviously, especially the volume of palatopharynx and glossopharyngeal segment, which is an effective method for the treatment of mild and moderate OSAHS.
2. the change of upper airway volume caused by the forward movement of the mandible is positively correlated with the amount of AHI change, that is, the more the volume of the upper airway is increased, the more the patient's respiratory condition is improved, and the change of upper airway volume is negatively correlated with the volume index of the patient, that is, the larger the volume index, the smaller the change of the volume of the upper airway.
3. the results of the study do not prove that the change of the upper airway volume caused by the mandibular forward movement has no significant correlation with the pre treatment AHI and the mandibular plane angle (FH-MP), that is, the changes in the volume of the upper airway and the severity of the OSAHS before treatment have no significant correlation with the size of the mandibular plane angle.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R766

【參考文獻】

相關期刊論文 前10條

1 張小軍;李曉陽;;OSAS力學機制研究及其進展[J];北京生物醫(yī)學工程;2008年03期

2 賈培增,傅民魁,曾祥龍;下頜前伸對阻塞性睡眠呼吸暫停綜合征患者上氣道形態(tài)的作用[J];北京大學學報(醫(yī)學版);2003年06期

3 劉月華,曾祥龍,傅民魁,黃席珍;阻塞性睡眠呼吸暫停綜合征患者顱頜面形態(tài)的X線頭影測量研究[J];北京醫(yī)科大學學報;1998年03期

4 尹國平;葉京英;常青林;;阻塞性睡眠呼吸暫停低通氣綜合征患者咽腔容積測量[J];中國耳鼻咽喉頭頸外科;2008年02期

5 郭涇;改良Herbst矯治器介入治療OSAS的療效分析及適應證研究[J];廣東牙病防治;2000年04期

6 張桂榮;李繼強;周青;;Silensor阻鼾器治療前后阻塞性睡眠呼吸暫停綜合征患者上氣道結構改變的分析[J];華西口腔醫(yī)學雜志;2006年01期

7 于美清;董福生;宋任東;劉懷軍;任貴云;黃勃源;雍平;馬文盛;盧海燕;;阻鼾器對無鼾正常鉭年輕人上氣道形態(tài)影響的磁共振研究[J];華西口腔醫(yī)學雜志;2007年04期

8 趙穎,曾祥龍;頸圍與阻塞性睡眠呼吸暫停綜合征的關系及其臨床意義[J];口腔正畸學;1999年03期

9 高雪梅,曾祥龍,傅民魁,黃席珍;口腔矯治器治療OSAS的下頜定位[J];口腔正畸學;2000年01期

10 趙穎,曾祥龍,傅民魁,黃席珍;阻鼾器對阻塞性睡眠呼吸暫停綜合征患者治療效果的研究[J];口腔正畸學;2001年01期

相關會議論文 前1條

1 賈培增;傅民魁;曾祥龍;;下頜前伸位對OSAS患者上氣道形狀的影響[A];第四軍醫(yī)大學口腔醫(yī)院2004第七屆全國口腔正畸學術會議論文匯編[C];2004年

，

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