CAJ | 학술논문

目的通过右美托咪定诱导睡眠内镜检查,观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者上气道塌陷特点.方法经多道睡眠图监测诊断为OSAHS的患者45例,右美托咪定诱导睡眠后内镜观察仰卧位患者睡眠期腭咽、口咽侧壁、舌根、会厌和喉部5个部位的塌陷情况,每个层面观察不少于3个呼吸暂停.应用ImageTool图像处理软件进行塌陷度计算,塌陷度≥75％为完全阻塞,塌陷度＜50％为无阻塞.结果 45例患者中1例各平面均无完全阻塞;6例只有单平面的完全阻塞;38例存在多平面完全阻塞,其中两平面完全阻塞17例,三平面完全阻塞15例,四平面完全阻塞6例.塌陷形态:①腭咽层面有环形狭窄43例次,其中41例次完全阻塞;②口咽侧壁层面X轴方向(左右径)塌陷,完全阻塞32例次;③舌根呈Y轴方向(前后径)塌陷,完全阻塞和不完全阻塞分别为11例次和10例次;④会厌层面X轴方向会厌塌陷表现为卷曲折叠成“V”字型,Y轴方向塌陷受舌根后坠影响与咽后壁贴合,严重软化者如活瓣堵塞喉入口,轻度则卷曲后与塌陷的咽侧壁形成环形狭窄;⑤喉部的杓区及杓会厌襞黏膜向声门区内翻,堵塞声门.结论右美托咪定诱导睡眠内镜检查可见上气道下部阻塞呈现多样性,咽侧壁、会厌和舌根的塌陷起重要作用,并发现喉部阻塞病例.
목적 통과우미탁미정유도수면내경검사,관찰조새성수면호흡잠정저통기종합정(OSAHS)환자상기도탑함특점.방법 경다도수면도감측진단위OSAHS적환자45례,우미탁미정유도수면후내경관찰앙와위환자수면기악인、구인측벽、설근、회염화후부5개부위적탑함정황,매개층면관찰불소우3개호흡잠정.응용ImageTool도상처리연건진행탑함도계산,탑함도≥75％위완전조새,탑함도＜50％위무조새.결과 45례환자중1례각평면균무완전조새;6례지유단평면적완전조새;38례존재다평면완전조새,기중량평면완전조새17례,삼평면완전조새15례,사평면완전조새6례.탑함형태:①악인층면유배형협착43례차,기중41례차완전조새;②구인측벽층면X축방향(좌우경)탑함,완전조새32례차;③설근정Y축방향(전후경)탑함,완전조새화불완전조새분별위11례차화10례차;④회염층면X축방향회염탑함표현위권곡절첩성“V”자형,Y축방향탑함수설근후추영향여인후벽첩합,엄중연화자여활판도새후입구,경도칙권곡후여탑함적인측벽형성배형협착;⑤후부적표구급표회염벽점막향성문구내번,도새성문.결론 우미탁미정유도수면내경검사가견상기도하부조새정현다양성,인측벽、회염화설근적탑함기중요작용,병발현후부조새병례.
Objective To identify the patterns of airway collapse in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) by dexmedetomidine induced sleep endoscopy.Methods Forty-five obstructive sleep apnea patients diagnosed by polysomnography were given dexmedetomidine intravenously.Once the patient was sedated in dorsal position,the electronic nasopharyngoscope was inserted transnasally and positioned on five levels of the upper airway sequentially (velum,oropharyngeal lateral wall,tongue base,epiglottis and larynx) to observe and document the collapse.Each level should be observed no less than three apneas.The degree of airway narrowing was calculated by using the ImageTool.No obstruction was defined when the degree of airway narrowing ＜ 50％,and complete obstruction when≥75％.Results In 45 patients with OSAHS,1 case showed no obstruction on any level,6 cases demonstrated obstructions on single level only,and 38 cases demonstrated complete obstructions on multilevel,including 17 cases with complete obstructions on two levels,15 cases complete obstructions on three levels,and 6 cases complete obstructions on four levels.The patterns of collapse found in the trial were:① circumferential stricture by velum collapse was found in 43 patients,and 41 cases showed complete obstructions; ② the side wall of oropharynx all collapsed in a lateral configuration,and 32 cases showed complete obstructions on this level; ③anteroposterior wallowing tongue base was common,11 cases showed partial obstructions on level of tongue base,and 10 cases complete; ④ epiglottic collapses occurred in lateral configuration folding as V shape; in anteroposterior configuration,epiglottis met posterior wall of the pharynx due to wallowing tongue base; the server soften epiglottis obstructed the entrance of the larynx,while the mild soften epiglottis and the collapsed side wall of pharynx came into being obstructions in concentric configuration; ⑤the arytenoid area and aryepiglottic fold mucosa inwardly covered the glottis when the obstruction occurred in the larynx.Conclusions The patterns of hypopharynx obstructions in OSAHS patients are multifarious.Lateral oropharyngeal wall,epiglottic and tone base collapse play an important role in the obstructions.The laryngeal obstruction can also be observed.