上气道测压在悬雍垂腭咽成形术后失败患者阻塞定位的应用

目的 应用上气道压力测定法判断悬雍垂腭咽成形术（uvulopalatopharyngoplsaty,UPPP）后失败患者气道阻塞部位。方法 对10例UPPP术后仍有打鼾或白天嗜睡的患者同期行整夜睡眠监测和上气道压力测定，判断其呼吸紊乱程度和气道阻塞部位，分析体位对呼吸紊乱低通气指数(apnea hypopnea index，AHI)的影响。结果 3例为中度，7例为重度阻塞性呼吸暂停。上气道阻塞部位可分上部（主要为腭后区）和下部（主要为舌后区），10例均为上部和下部联合阻塞，其中6例以上部，4例以下部阻塞为主。仰卧位呼吸暂停AHI（66.52±22.51）次/h，侧卧位AHI（47.82±21.82）次/h，差异有统计学意义（P=0.017）。结论 上气道压力测定法可较好地判断阻塞性睡眠呼吸暂停低通气综合征患者的气道阻塞部位，多数UPPP术后患者以腭后区阻塞为主，且仰卧位较侧卧位更易引起气道塌陷。

Effect of upper airway pressure measurements for obstructive sites in uvulopalatopharyngoplasty failures

Objective To determine the sites of upper airway collapse by upper airway pressure measurements in subjects demonstrated to have obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP). Methods Nocturnal polysomnography and continuous upper airway pressure measurements with ApneaGraph were performed on 10 subjects with subjective snoring or excessive daytime sleepiness after UPPP. The ApneaGraph transducer catheter contained two pressure sensors and two temperature sensors used for determination of the obstruction sites and the apnoeic events during sleep. The obstructive sites were in the upper (retropalatal oropharynx) or lower levels( the retroglossal region). The lower limit of the upper airway obstruction was determined by the pressure patterns. The constituent ratio was used to reflect the obstructive proportion of different levels. The effects of posture on apnea hypopnea index(AHI) were also analyzed. Results 3 patients had moderate OSA and 7 patients had severe OSA. 6(60%) cases had predominant sites of obstructions in the upper level(the constituent ratio of the retropalatal obstruction ＞50%), and 4 patients(40%) in the lower level(the constituent ratio of the retroglossal obstruction＞50%). The supine AHI(66.52±22.51) was higher than the lateral AHI(47.82±21.82) and the difference between them was significant(P=0.017). Conclusion Upper airway pressure measurements can accurately identify the level of upper airway obstruction. Most patients with OSA following UPPP have the predominant obstructive sites at the retropalatal oropharynx and they tend to have more AHI in the supine position than in the lateral position.