CAJ | 학술논문

目的比较睡眠状态下256层螺旋CT扫描与光纤内镜技术在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)上气道定位诊断的符合率及优缺点,探讨其临床应用价值.方法对海军总医院耳鼻咽喉头颈外科2011年4月至2012年7月收治的59例经多导睡眠监测确诊的OSAHS患者分别行清醒、诱导睡眠状态下上气道螺旋CT扫描及清醒状态下光纤内镜检查,判定OSAHS患者的上气道阻塞部位,行前瞻性研究.结果所有患者均顺利完成实时CT扫描.(Ⅰ)发现单纯软腭后区阻塞或狭窄者,实时CT 26例,光纤内镜检查34例；发现软腭后区+舌后区阻塞或狭窄者,实时CT19例,光纤内镜检查10例；发现软腭后区+会厌后区阻塞或狭窄者,实时CT 6例,光纤内镜检查2例；发现软腭后区+舌后区+会厌后区阻塞或狭窄者,实时CT 7例,光纤内镜检查3例；软腭后区+舌后区+会厌后均未见阻塞或狭窄者,实时CT1例,光纤内镜检查10例；实时CT与光纤内镜检查均未发现单纯舌后区及会厌后区狭窄或阻塞者.(2)对比两种方法判定OSAHS患者软腭后区、舌后区、会厌后区阻塞或狭窄阳性率,实时CT扫描阳性率均高于光纤内镜检查,差异均有统计学意义(均P＜0.05)[软腭后区:98.3％(58例)比81.4％(48例),x2=5.82,P ＜0.05;舌后区:44.1％(26例)比22.0％(13例),x2=9.60,P＜0.01;会厌后区:22.0％(13例)比8.5％(5例),x2=4.90,P＜0.05].结论药物诱导睡眠实时CT扫描较之光纤内镜检查可获得更多上气道解剖学信息,可为OSAHS诊治提供更为全面、客观的形态学依据.
목적 비교수면상태하256층라선CT소묘여광섬내경기술재조새성수면호흡잠정저통기종합정(OSAHS)상기도정위진단적부합솔급우결점,탐토기림상응용개치.방법 대해군총의원이비인후두경외과2011년4월지2012년7월수치적59례경다도수면감측학진적OSAHS환자분별행청성、유도수면상태하상기도라선CT소묘급청성상태하광섬내경검사,판정OSAHS환자적상기도조새부위,행전첨성연구.결과 소유환자균순리완성실시CT소묘.(Ⅰ)발현단순연악후구조새혹협착자,실시CT 26례,광섬내경검사34례；발현연악후구+설후구조새혹협착자,실시CT19례,광섬내경검사10례；발현연악후구+회염후구조새혹협착자,실시CT 6례,광섬내경검사2례；발현연악후구+설후구+회염후구조새혹협착자,실시CT 7례,광섬내경검사3례；연악후구+설후구+회염후균미견조새혹협착자,실시CT1례,광섬내경검사10례；실시CT여광섬내경검사균미발현단순설후구급회염후구협착혹조새자.(2)대비량충방법판정OSAHS환자연악후구、설후구、회염후구조새혹협착양성솔,실시CT소묘양성솔균고우광섬내경검사,차이균유통계학의의(균P＜0.05)[연악후구:98.3％(58례)비81.4％(48례),x2=5.82,P ＜0.05;설후구:44.1％(26례)비22.0％(13례),x2=9.60,P＜0.01;회염후구:22.0％(13례)비8.5％(5례),x2=4.90,P＜0.05].결론 약물유도수면실시CT소묘교지광섬내경검사가획득경다상기도해부학신식,가위OSAHS진치제공경위전면、객관적형태학의거.
Objective To compare 256-layer spiral computed tomography (CT) scan in sleep and laryngofiberscope technology for locating obstructive sites of upper airway in patients with obstructive sleep apnea hypopnea syndrome,analyze their advantages and disadvantages and discuss the clinical application values.Methods A total of 59 patients with OSAHS diagnosed by polysomnography underwent spiral CT scan in awake and drug-induced sleep states and laryngofiberscope examination in awake state to assess the sites of airway obstruction.Results Real-time CT scans were completed successfully in all patients.There were airway obstruction at isolated retropalatal region (real-time CT rcvealing n =26,laryngofiberscope revealing n =34),retropalatal and retroglottal regions simultaneously (real-time CT revealing n =19,laryngofiberscope revealing n =10),retropalatal and epiglottal regions simultaneously (real-time CT revealing n =6,laryngofiberscope revealing n =2),retropalatal and retroglottal and epiglottal regions simultaneously (real-time CT revealing n =7,laryngofiberscope revealing n =3) and no airway obstruction (real-time CT revealing n =1,laryngofiberscope revealing n =10).There was not solitary airway obstruction at retroglottal or epiglottal region.The results of real-time CT scans and laryngofiberscope examination were statistically significant different in all regions,and real-time CT scanning compared with laryngofiberscope found more obstructive sites of upper airway [retropalatal region:98.3％ (n =58) vs 81.4％ (n =48),x2 =5.82,P＜0.05; retroglottal regions:44.1％ (n =26) vs 22.0％ (n =13),x2 =9.60,P ＜0.01;epiglottal regions:22.0％(n=13) vs8.5％(n=5),x2 =4.90,P＜0.05].Conclusion Compared with laryngnfiberscope examination,real-time dynamic CT scans in drug-induced sleep state could get more information about anatomy changes of upper airway,providing relatively objective morphological basis for diagnosis and treatment of patients with OSAHS.