上气道多层CT和测压法对OSAHS阻塞定位的比较研究

目的评价MSCT测量和上气道压力测定判定阻塞性睡眠呼吸暂停低通气综合征(OSAHS)病人上气道阻塞部位的诊断符合率及优缺点。方法对29例OSAHS病人分别在清醒时应用16层螺旋CT扫描测量上气道最小轴面积以及睡眠中上气道测压方法确定咽腔阻塞部位。结果腭后区及舌后区为主的阻塞两种方法符合率均为22/29。两种方法确定腭后区为主的阻塞分别占25/29(CT测量)和22/29(上气道测压);CT测量发现3例腭、舌后区咽腔双重狭窄,未发现单纯舌后区狭窄病例;上气道测压判定全部病例均为腭、舌后区咽腔双重阻塞,但不同病例腭、舌后区阻塞频度不同,多为腭后区阻塞为主,舌根平面阻塞为主4例。结论上气道测压与CT测量均可较好评价腭后区阻塞,对发现舌后区的阻塞差异较大,有待进一步研究。两种方法各有优缺点,二者结合可提高诊断率。

Comparative study of determining the site of airway obstruction in obstructive sleep apnea-hypopnea between MSCT and airway press measurements

Objective To compare MSCT and upper airway pressure monitoring for locating the sites of obstruction in the upper airway of patients with obstructive sleep apnea-hypopnea syndrome, and analyze their advantages and shortages respectively. Methods The upper airway smallest cross-sectional areas of twenty-nine patients with OSAHS were measured by using 16-slice spiral CT. The upper airway pressure was monitored for these patients. Results The identical result of obstruction mainly occurred in retropalatal or retroglossal area was obtained by CT and upper airway pressure monitoring in 22/29. The obstruction mainly occurred in retropalatal area was found in 25/29 by CT and 22/29 by upper airway pressure monitoring, respectively. In three cases, the obstruction was found in both retropalatal and retroglossal space by CT. The obstruction only occurred in retroglossal space was not found by CT, by upper airway pressure monitoring, all cases were found the obstruction in retropalatal and retroglossal space, but the most in retropalatal space. Four cases were found the obstruction mainly occurred in retroglossal space by upper airway pressure monitoring. Conclusion Two methods, CT and upper airway pressure monitoring, are good enough for evaluating obstruction in retropalatal area of upper airway, but are very different in retroglossal space. There are different advantages and shortages in the two methods, and it is beneficial for diagnosis and treatment of OSAHS combining with CT and upper airway pressure monitoring.