鼻咽3D-CT检查对OSAHS患者术前评估的临床意义

Clinical significance of preoperative nasopharynx 3D-CT in OSAHS patients

关键词:  阻塞性睡眠呼吸暂停低通气综合征  阻塞性  鼻咽3D-CT

Key words:  obstructive sleep apnea hypopnea syndrome  obstructive  nasopharynx 3D-CT

摘要:

目的　研究鼻咽3D-CT检查对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者术前评估的临床意义。　方法　选择中国医科大学附属第一医院耳鼻咽喉科收治的OSAHS患者82例作为OSAHS组；另选择同期收治的非OSAHS患者60例为对照组，两组术前均行鼻咽3D-CT检查，且对OSAHS患者行多导睡眠监测(PSG)。通过鼻咽3D-CT立体空间测量硬腭后缘与咽后壁距离（L1）、硬腭水平与鼻咽腔横径（L2）、悬雍垂后缘与咽后壁距离（L3）、软腭厚度（L4）、悬雍垂厚度（L5）、会厌尖水平舌根与咽后壁距离（L6）、会厌尖与咽后壁距离（L7）、舌骨水平舌骨正中与咽后壁距离（L8）及硬腭至舌骨水平咽腔最短横径（L9）。比较分析鼻咽3D-CT检查数据，应用相关性检验评估鼻咽3D-CT各测量值与PSG监测的呼吸暂停低通气指数(AHI)及阻塞性呼吸暂停指数（OAI）的关系。　结果　OSAHS组术前AHI为（42.75±23.22）次/h，OAI为（20.29±18.60）次/h；术前OSAHS组鼻咽3D-CT测量平均值依次L1为（20.39±4.34）mm，L2为（18.57±2.55）mm，L3为（5.49±2.87）mm，L4为（6.52±2.68）mm，L5为(2.85±1.86)mm，L6为（12.87±6.84）mm，L7为（8.76±5.06）mm，L8为（31.52±7.57）mm，L9为（12.02±6.71）mm，与对照组患者比较各指标差异均有显著性意义（P<0.05）。鼻咽3D-CT及PSG两种检查指标的相关性检验分析显示，L4和L5分别与AHI及OAI呈正相关，L1、L2、L3、L6和L9分别与AHI及OAI呈负相关。　结论　　鼻咽3D-CT通过其立体空间测量技术了解OSAHS患者的咽峡结构特点，为不同OSAHS患者术前评估制定个性化手术方案提供重要的客观临床指导。

Abstract:

Objective To study the clinical significance of nasopharynx 3D-CT in preoperative evaluation of obstructive sleep apnea hypopnea syndrome (OSAHS) patients. Methods 82 patients with OSAHS were randomly selected in our hospital，and 60 non-OSAHS patients treated in the same period were selected as the control group. All patients received 3D-CT examination before operation，and OSAHS patients were treated with PSG. By measuring the hard palate and the posterior pharyngeal wall edge distance (L1）, nasal cavity diameter in hard palate horizontal (L2），extent from free edge of uvula to postpharyngeal (L3），the depth of soft palate (L4），the depth of uvula (L5），in the level of epiglottis tip the tongue and the posterior pharyngeal wall distance (L6），the epiglottis tip and the posterior pharyngeal wall distance (L7），in the middle level of the hyoid bone hyoid and the posterior pharyngeal wall distance (L8） and the shortest distance of the Pharynx (L9），we investigated the characteristics of pharyngeal cavity. 3D-CT inspection data were compared and used in correlation hypothesis test and association evaluation between measuring mean and effect. Results The preoperative PSG revealed AHI（42.75±23.22）frequency per hour and OAI（20.29±18.60）frequency per hour. The mean values of preoperative measurement by nasopharynx 3D-CT were L1（20.39±4.34）mm，L2（18.57±2.55）mm，L3（5.49±2.87）mm，L4（6.52±2.68）mm，L5 (2.85±1.86) mm，L6（12.87±6.84）mm，L7（8.76±5.06）mm， L8（31.52±7.57）mm， and L9（12.02±6.71）mm. Compared to the control group，the differences of 3D-CT index were statistically significant (P<0.05）. By using the correlation hypothesis test and evaluating the association between nasopharynx 3D-CT and PSG，L4 and L5 had the positive correlation，L1，L2，L3，L6 and L9 had the negative correlation. Conclusions We use the nasopharynx 3D-CT, which has three-dimensional space measurement techniques, to evaluate the characteristics of pharyngeal cavity. Its application in preoperative evaluation has significantly guided treatment options.