本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + 軟腭�。� 參考：《安徽醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的研究阻塞性睡眠呼吸暫停低通氣綜合征（obstructive sleep apnea/hypopneasyndrome，OSAHS）患者上氣道阻塞的部位，研究阻塞部位除了解剖學(xué)因素參與OSAHS的發(fā)生，是否還存在神經(jīng)肌肉調(diào)節(jié)的異常參與了OSAHS的發(fā)生。方法1.選擇經(jīng)我院PSG(Polysomnography，多導(dǎo)睡眠監(jiān)測(cè))診斷的100例OSAHS患者行常規(guī)的體格檢查，例如身高、體重、頸圍、是否有頜面結(jié)構(gòu)異常，專科檢查，例如鼻咽、口咽、喉咽等處是否有解剖學(xué)上的阻塞，纖維鼻咽喉鏡檢查結(jié)合Muller實(shí)驗(yàn)，上氣道CT掃描范圍為環(huán)狀軟骨到鼻咽頂?shù)让鞔_患者上氣道易發(fā)生阻塞的部位。2.選擇30例經(jīng)我院PSG檢查診斷為OSAHS的患者作為實(shí)驗(yàn)組，10例經(jīng)PSG檢查排除OSAHS的單純慢性扁桃體炎患者作為對(duì)照組。通過HE染色檢測(cè)實(shí)驗(yàn)組和對(duì)照組軟腭組織中末梢神經(jīng)的分布，通過免疫組化檢測(cè)實(shí)驗(yàn)組和對(duì)照組軟腭組織中蛋白基因產(chǎn)物9.5（protein gene product9.5，PGP9.5）、神經(jīng)細(xì)胞黏附因子（neural cell adhesion molecule，NCAM）的表達(dá)，PGP9.5、NCAM的表達(dá)水平采用累積光密度（integrated optical density，IOD）進(jìn)行半定量測(cè)定。比較實(shí)驗(yàn)組和對(duì)照組中PGP9.5及NCAM的IOD的差異及對(duì)照組中PGP9.5及NCAM表達(dá)水平與AHI的關(guān)系。 結(jié)果1.常規(guī)�？茩z查：鼻腔結(jié)構(gòu)較正常狹窄者共80例，以鼻中隔偏曲及慢性肥厚性鼻炎較常見。根據(jù)Friedman分級(jí)，見腭舌關(guān)系2°共13例，腭舌關(guān)系3°共36例，，腭舌關(guān)系4°共51例。纖維鼻咽喉鏡檢查結(jié)合Muller實(shí)驗(yàn)：鼻咽部狹窄的共80例，口咽部狹窄中腭后區(qū)氣道狹窄的共98例，單純腭后區(qū)氣道狹窄的共32例，腭后區(qū)狹窄合并舌后區(qū)狹窄66例，單純舌后區(qū)狹窄2例。上氣道CT掃描檢查：鼻咽部狹窄81例，口咽部狹窄中98例腭后區(qū)氣道狹窄，33例單純腭后區(qū)氣道狹窄，65例腭后區(qū)狹窄合并舌后區(qū)狹窄，單純舌后區(qū)狹窄2例。2.（1）實(shí)驗(yàn)組軟腭不同層次組織中末梢神經(jīng)的分布不同，末梢神經(jīng)主要分布在黏膜下層、腺體、血管周圍，肌肉組織周圍少量分布；（2）實(shí)驗(yàn)組OSAHS患者軟腭組織中PGP9.5及NCAM表達(dá)水平明顯高于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）；（3）PGP9.5和NCAM的表達(dá)水平與呼吸暫停低通氣指數(shù)（AHI）呈正相關(guān)（分別為r=0.706，P=0.01；r=0.636，P=0.01）。 結(jié)論（1）OSAHS患者最易發(fā)生阻塞的部位為軟腭后區(qū)，舌后區(qū)平面阻塞也占重要比例， OSAHS患者軟腭具有解剖學(xué)上的狹窄；（2）常規(guī)專科檢查、纖維鼻咽喉鏡檢查、上氣道CT檢查結(jié)合能更好的確定OSAHS患者上氣道的阻塞部位； （3）OSAHS患者和非OSAHS者軟腭組織中同樣存在末梢神經(jīng)及神經(jīng)反射； （4）OSAHS患者軟腭組織中末梢神經(jīng)的分布及神經(jīng)肌肉支配存在異常，且與病情嚴(yán)重程度密切相關(guān)。
[Abstract]:Objective to study the location of upper airway obstruction in patients with obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea / hypopnea syndrome). Method 1. A total of 100 OSAHS patients diagnosed by PSG (polysomnography) were selected for routine physical examination, such as height, weight, neck circumference, abnormal maxillofacial structure, and specialized examinations, such as nasopharynx, oropharynx, etc. If there is anatomic obstruction in laryngopharynx, fiberoptic rhinolaryngoscopy combined with Muller's experiment, the CT scan range of upper airway is from annular cartilage to nasopharynx top. Thirty patients with OSAHS diagnosed by PSG in our hospital were selected as experimental group and 10 patients with simple chronic tonsillitis who were excluded from OSAHS by PSG examination as control group. The distribution of peripheral nerves in soft palate tissue of experimental group and control group was detected by HE staining. The expression of protein gene product 9.5 (protein gene product 9.5 and nerve cell adhesion factor (neural cell adhesion 9.5 in soft palate tissue of experimental group and control group were detected by immunohistochemistry. The expression level of PGP9.5NCAM in soft palate tissue was measured by (integrated optical density (integrated optical). The difference of IOD in PGP 9.5 and NCAM between experimental group and control group and the relationship between PGP 9.5 and NCAM expression level and AHI in control group were compared. Result 1. Routine examination showed that 80 patients with normal nasal stenosis were found to have nasal septum deviation and chronic hypertrophic rhinitis. According to Friedman's classification, there were 13 cases of palatoglossal relation (2 擄), 36 cases of palatoglossal relation (3 擄) and 51 cases of palatoglossal relationship (4 擄). The results were as follows: 80 cases of nasopharynx stenosis, 98 cases of posterior palatine airway stenosis, 32 cases of simple posterior palatine airway stenosis, 66 cases of posterior palatal area stenosis. There were 2 cases of simple posterior lingual stenosis. Ct scan of upper airway: nasopharynx stenosis in 81 cases, oropharyngeal stenosis in 98 cases, posterior palatine area airway stenosis in 33 cases, simple posterior palatine area airway stenosis in 65 cases, posterior palatine area stenosis with posterior lingual area stenosis in 65 cases. (1) the distribution of peripheral nerves in different layers of soft palate in the experimental group was different. The peripheral nerves were mainly distributed in the submucosa, glands, blood vessels, and a small amount of muscle tissue. (2) the expression levels of PGP9.5 and NCAM in soft palate of OSAHS patients in the experimental group were significantly higher than those in the control group (P0.05). The expression levels of PGP9.5 and NCAM were positively correlated with apnea hypopnea index (AHI) (P < 0.05). Conclusion (1) the most likely site of obstruction in OSAHS patients is the posterior soft palate, the posterior lingual area is also an important part, the soft palate has anatomic stricture in OSAHS patients, (2) routine specialized examination, fiberoptic rhinolaryngoscopy examination, Ct examination of upper airway can better determine the location of obstruction of upper airway in OSAHS patients. (3) peripheral nerve and nerve reflex are also present in soft palate tissues of OSAHS patients and non-OSAHS patients. (4) the distribution and neuromuscular innervation of peripheral nerves in soft palate tissue of OSAHS patients were abnormal, and were closely related to the severity of the disease.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R766

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