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目的探讨上气道影像学在不同性别阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者病情严重程度中的预测作用。方法对163例经多导睡眠监测(PSG)确诊为OSAHS患者(男98例,女65例),行平静呼吸时上气道CT扫描,测量舌骨下缘距下颌骨下缘(颏下点)的垂直距离(D-HM)、舌骨最前点距下颌骨下缘(颏下点)的距离等CT参数,并进行各测量值与睡眠呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(LSaO_2)的相关性分析。结果 (1)AHI。男性患者14.2~52.3次/h,平均(36.22±5.64)次/h;女性患者9.6~46.4次/h,平均(29.38±3.90)次/h;(2)LSaO_2。男性患者48%~79%,平均(63.93%±10.51%);女性患者59%~87%,平均(70.92%±9.17%);(3)各研究平面的最小前后径、左右径及面积与AHI的大小均呈负相关,与LSaO_2呈正相关,且男性OSAHS患者AHI、LSaO_2与腭后区最小截面积相关性更明显(r=-0.441,P<0.01),而女性OSAHS患者AHI、LSaO_2与舌后区最小截面积相关性更明显(r=-0.403,P<0.01);(4)不同性别之间舌骨下缘距下颌骨下缘(颏下点)的垂直距离(D-HM)、舌骨最前点距下颌骨下缘(颏下点)的距离差异具有统计学意义(P<0.01);(5)对部分OSAHS患者行改良UPPP手术,术后3个月,男性OSAHS患者总有效率为84.31%,女性OSAHS患者总有效率为58.06%,CT测量值男性OSAHS患者有4个数值与术前相比有统计学意义,而女性患者有1个数值与术前相比有统计学意义。结论 OSAHS患者上气道CT的测量指标可对OSAHS病情的严重程度有一定预测作用,且不同性别之间的测量数值差异有统计学意义,需根据性别的不同来制定个体化诊疗意见。
Objective To investigate the predictive value of upper airway imaging in the severity of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods One hundred and sixty-three OSAHS patients (98 males and 65 females) diagnosed by polysomnography (PSG) were enrolled in this study. Upper airway CT scans were performed during calm breathing. The lower edge of hyoid bone was measured from the lower edge of mandible (D-HM), the distance between the foremost point of hyoid bone and the inferior edge of mandible (submental point), and the relationship between the measured value and sleep apnea hypopnea index (AHI), minimum arterial oxygen Saturation (LSaO_2) correlation analysis. Results (1) AHI. 14.2 ~ 52.3 times / h in male patients (36.22 ± 5.64) / h in average; 9.6 ~ 46.4 times / h in female patients (average 29.38 ± 3.90) / h; (2) LSaO_2. (63.93% ± 10.51%) in male patients and 59% ~ 87% (70.92% ± 9.17%) in female patients. (3) The minimum anteroposterior diameter, left and right diameter and area of each study plane were AHI was negatively correlated with the size of LSaO_2, and the correlation between AHI, LSaO_2 and minimum palatal area was more significant in male patients with OSAHS (r = -0.441, P <0.01) (R = -0.403, P <0.01); (4) The vertical distance (D-HM) between the lower hyoid margin and the lower edge of the mandible (submental point) , And the distance between the foremost point of hyoid bone and the inferior margin of mandible (submental point) was statistically significant (P <0.01). (5) Some patients with OSAHS underwent modified UPPP surgery. At 3 months after operation, The effective rate was 84.31%. The total effective rate of female OSAHS patients was 58.06%. The CT measurement values of 4 male OSAHS patients were statistically significant compared with the preoperative values, while the female patients had 1 value statistically compared with preoperative Significance of learning. Conclusion The measurement of upper airway CT in OSAHS patients can predict the severity of OSAHS. There are significant differences in the measurement values between different sexes. Individualized diagnosis and treatment opinions should be made according to different sexes.