山东大学耳鼻喉眼学报 ›› 2016, Vol. 30 ›› Issue (5): 29-32.doi: 10.6040/j.issn.1673-3770.0.2016.340

• 睡眠呼吸障碍性疾病 • 上一篇    下一篇

内镜检查及上气道压力测定对阻塞性睡眠呼吸暂停低通气综合征患者上气道的评估价值

田旭,霍红,李五一,王剑,杨大海   

  1. 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科, 北京 100730
  • 收稿日期:2016-08-03 出版日期:2016-10-20 发布日期:2016-10-20
  • 通讯作者: 霍红. E-mail:huohong_pumch@sina.com E-mail:tianxu214@163.co
  • 作者简介:田旭. E-mail:tianxu214@163.co

Endoscopy with Müllers maneuver and airway pressure measurement method on the evaluation of the upper airway of obstructive sleep apnea hypopnea syndrome.

TIAN Xu, HUO Hong, LI Wuyi, WANG Jian, YANG Dahai   

  1. Department of Otolaryngology &Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2016-08-03 Online:2016-10-20 Published:2016-10-20

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摘要： 目的 通过比较清醒时内镜检查及夜间上气道压力测定法在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者术前上气道评估中的作用,探讨内镜检查对OSAHS上气道评估的临床价值。 方法 对OSAHS患者125例进行内镜检查判断上气道阻塞部位及塌陷方式,同期应用睡眠监测及上气道阻塞定位系统(AG)行整夜的睡眠监测上气道压力测定,对两种检查方法进行比较。 结果 内镜检查示,患者均有腭后区阻塞,舌后区阻塞74例,但塌陷方式不同;比较内镜检查的单纯腭后区阻塞组及腭后区、舌后区多平面阻塞组的AG测量值,下部阻塞低通气指数(AHI)及下部阻塞构成比的差异有统计学意义(P均<0.01)。 结论 内镜检查对于判断上气道阻塞部位及塌陷方式具有一定的临床价值,与AG相结合,指导手术方案的选择。

关键词: 上气道, 电视内镜, 睡眠呼吸暂停,阻塞性, 测压法, Müller手法

Abstract: Objective To compare daytime video-endoscopy with Müllers maneuver and nocturnal airway pressure measurement for upper airway(UA)assessment in patients with obstructive sleep apnea and hypopnea syndrome(OSAHS), in order to explore the clinical value of daytime endoscopy in airway evaluation. Methods A total of 125 OSAHS cases were evaluated by daytime video-endoscopy with Müllers maneuver to determine the sites of obstruction and patterns of collapse. The cases also underwent nocturnal pressure measurements(ApneaGraph, AG)to identify obstruction sites. The results of the two methods were compared. Results Endoscopy with Müllers maneuver detected retropalatal obstruction in all cases, of which 74 had retroglossal obstruction, and the patterns of collapse were different. AG results showed that lower apnea hypopnea index(AHI)and the proportion of lower AHI were significantly higher in multilevel obstruction group than in isolated retropalatal obstruction group(all P<0.01). Conclusion Daytime endoscopy with Müllers maneuver is of clinical value to evaluate the sites of obstruction and patterns of UA collapse. Combined with AG, it can help to guide the choice of surgical plan.

Key words: Sleep apnea hypopnea syndrome, obstructive, Video-endoscopy, Manometry, Upper airway, Müllers maneuver

中图分类号: 

  • R766.7
[1] Chai-Coetzer C L, Luo Y M, Antic N A, et al. Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study[J]. Sleep, 2013, 36(12):1929-1937.
[2] Borowiecki B D, Sassin J F. Surgical treatment of sleep apnea[J]. Arch Otolaryngol, 1983, 109(8):508-512.
[3] 李五一, 倪道凤, 姜鸿, 等. OSAS患者咽腔阻塞定位预测UPPP疗效[J]. 临床耳鼻咽喉科杂志, 2003, 17(3):145-146. LI Wuyi, NI Daofeng, JIANG Hong, et al. Predictive value of sleep nasendoscopy and the Müller maneuver in uvulopalatopharyngoplasty for the obstructive sleep apnea syndrome[J]. Clin J Otorhinolarynol, 2003, 17(3):145-146.
[4] Aboussouan L S, Golish J A, Wood B G, et al. Dynamic pharyngoscopy in predicting outcome of uvulopalatopharyngoplasty for moderate and severe obstructive sleep apnea[J]. Chest, 1995, 107(4):946-951.
[5] Sher A E, Thorpy M J, Shprintzen R J, et al. Predictive value of Müller maneuver in selection of patients for uvulopalatopharyngoplasty[J]. Laryngoscope, 1985, 95(12):1483-1487.
[6] 韩德民, 叶京英, 李彦茹, 等. 上气道持续压力测定预测悬雍垂腭咽成形术的疗效[J]. 中华耳鼻咽喉头颈外科杂志, 2006, 4l(10):753-758. HAN Demin, YE Jingying, LI Yanru, et al. Preoperative overnight airway pressure measurement for predicting the outcome of revised uvulopalatopharyngoplasty[J]. Chin J Otorhinolarynol Head Neck Surg, 2006, 41(10):753-758.
[7] 神平, 李五一, 田旭, 等. 上气道测压阻塞定位在阻塞性睡眠呼吸暂停低通气综合征外科治疗中的应用[J]. 中华耳鼻咽喉头颈外科杂志, 2010, 45(12):1008-1013. SHEN Ping, LI Wuyi, TIAN Xu, et al. Outcomes of upper airway reconstructive surgery for moderate to severe obstructive sleep apnea syndrome based on upper airway pressure measurements[J]. Chin J Otorhinolarynol Head Neck Surg, 2010, 45(12):1008-1013.
[8] Tvinnereim M, Mitic S, Hamsen R K. Plasma radiofrequency preceded by pressure recording enhances success for treating sleep-related breathing disorders[J]. Laryngoscope, 2007, 117(4):73l-736.
[9] 霍红, 李五一, 田旭, 等. 鼻咽通气管用于上气道阻塞定位临床价值的初步研究[J]. 中华耳鼻咽喉头颈外科杂志, 2014, 49(9):743-747. HUO Hong, LI Wuyi, TIAN Xu, et al. Preliminary research on clinical value of localization of upper airway obstruction with nasopharyngeal airway combined with polysomnography[J]. Chin J Otorhinolarynol Head Neck Surg, 2014, 49(9):743-747.
[10] 田旭, 李五一, 霍红, 等. 上气道测压与Friedman分型在上气道阻塞平面判断中的相关性研究[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(8):622-627. TIAN Xu, LI Wuyi, HUO Hong, et al. Clinical value of upper airway pressure measurement and Friedman staging system in preoperative evaluation for obstructive sleep apnea hypopnea syndrome[J]. Chin J Otorhinolarynol Head Neck Surg, 2011, 46(8):622-627.
[11] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会咽喉学组. 阻塞性睡眠呼吸暂停低通气综合征诊断依据和外科治疗指南[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(2):95-96.
[12] Lee C H, Won T B, Cha W, et al. Obstructive site localization using multisensor manometry versus the Friedman staging system in obstructive sleep apnea[J]. Eur Arch Otorhinolaryngol, 2008, 265(2):171-177.
[13] Ritter C T, Trudo F J, Goldberg A N, et al. Quantitative evaluation of the upper airway during nasopharyngoscopy with the Müller maneuver[J]. Laryngoscope, 1999, 109(6):954-963.
[14] Abdullah B, Rajet K A, Abd Hamid S S, et al. A videoendoscopic evaluation of the upper airway in South East Asian adults with obstructive sleep apnea[J]. Sleep Breath, 2011, 15(4):747-754.
[15] Hsu P P, Tan A K, Tan B Y, et al. Uvulopalatopharyngoplasty outcome assessment with quantitative computer-assisted videoendoscopic airway analysis[J]. Acta Otolaryngol, 2007, 127(1):65-70.
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