The value of the pharyngeal airway pressure monitoring test in topodiagnosis of OSA
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摘要: 目的 探讨一种鼻咽喉镜检查联合Müller’s试验的改良方法—咽部气道正负压监测试验(PAPMT)对OSA定位诊断的意义。方法 对101例OSA患者(OSA组)及30例无鼾症症状及相关疾病患者(对照组)进行PAPMT。在压力监测下，电子喉镜前端分别停留在腭咽及舌咽平面，先观察最大吸气、呼气压力，然后测量并记录在不同压力下腭咽、舌咽平面截面积变化情况，最后结合PSG进行相关分析。结果 ① OSA组PAPMT时最大吸气压力分布在-1~-8 kPa，其中>-2 kPa占2.0%(2/101)；>-4 ~-2 kPa占43.5%(44/101)，>-6 ~-4 kPa占45.6%(46/101)，≤-6 kPa占8.9%(9/101)。②OSA组腭咽、舌咽截面积变化明显大于对照组，2组气道顺应性存在明显差异。③OSA组在最大吸气压力时腭咽平面阻塞率为96.0%，舌咽平面阻塞率为34.3%；对照组无咽腔阻塞。④腭咽平面阻塞以左右狭窄为主(73.0%)，主要表现为咽侧壁肥厚；舌咽平面阻塞以前后狭窄为主(71.0%)，表现为舌根肥大、舌扁桃体增生及舌根后坠。⑤在压力为±4 kPa时，腭咽、舌咽平面截面积变化程度比压力±2 kPa时大。⑥压力分别为±2 kPa时，腭咽平面截面积变化程度比舌咽平面截面积变化程度大，左右径变化大于前后径。⑦在腭咽、舌咽平面，截面积的变化程度与OSA严重程度、吸气压力显著相关。结论 PAPMT可观察固定压力下的上气道截面积变化，判断阻塞部位，为选择治疗方法提供指导。OSA患者腭咽平面狭窄较多见。腭咽、舌咽平面截面积狭窄程度和变化程度可反映OSA严重程度。
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关键词:
- 睡眠呼吸暂停，阻塞性 /
- Müller’s试验 /
- 正负压试验 /
- 多导睡眠监测 /
- 电子喉镜
Abstract: Objective To analyses the value of an improved methods of Muller's test, pharyngeal airway pressure monitoring test(PAPMT), in topodiagnosis of OSA.Method One hundred and one cases with OSA(AHI≥5 times per hour) and 30 normal adults were included in the study. Under the pressure monitoring, the electronic laryngoscope were stayed at the palatopharyngeal and glossopharyngeum. First, observe the maximum expiratory pressure and the minimum spiratory pressure. And then measure and record changes of pharynx cross-sectional area at palatopharyngeal and glossopharyngeum under the different pressure. At Last, analyses the correlation between changes of Pharynx cross-sectional area with polysomnography(PSG).Result ① In 101 cases with OSA, the maximal inspiratory pressure of Müller's manerver distribution is between 1 and 8 kPa. ②The changes of pharynx cross-sectional area of OSA at palatopharyngeal and glossopharyngeum is significantly greater than the control group, and there were obvious differences between OSA and the control group. ③In OSA group, the plug rate at palatopharyngea was 96% and the plug rate at glossopharyngeum is 34% at the minimum pressure. There are no cases have pharynx jams at the control group. ④The main cause of the palatopharyngeal obstruction was strictures in left and right(73%), and the anatomical factors causing obstruction mainly were, thicken of the pharyngeal wall. The main cause of the hypopharyngeal obstruction was strictures in front and back(71%), and the redundant lymph tissue at tongue base and posterior displacement of the tongue base, and collapse of pharyngeal wall played an important role at tongue-pharyngeal obstruction. ⑤The changes of pharynx cross-sectional area at palatopharyngeal and glossopharyngeum when the pressure is ±4 kPa is greater than when the pressure is ±2 kPa. ⑥When the pressure is ±2 kPa, The changes of pharynx cross-sectional area at palatopharyngeal is greater than at glossopharyngeum. ⑦Diminished pharyngeal apertures and collapsibility were associated with increased rates of apnea and hypopnea index and the suction pressure(P < 0.05).Conclusion ① PAPMT is able to measure and calculate the changes of pharynx cross-sectional area, determine the site of obstruction, and help the treatment. ②The primary site of obstruction is at velopharyngeal in OSA group. ③The changes of pharynx cross-sectional area at palatopharyngeal and glossopharyngeum of patients can reflects the severity of the OSA. -
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表 1 2组患者一般情况比较
组别 例数 年龄/岁 身高/m 体重/kg BMI 男 女 OSA组 92 9 43.18±10.36 1.68±0.06 69.0±14.181) 27.68±4.191) 对照组 27 3 43.25±8.96 1.70±0.12 58.23±10.19 24.13±2.37 与对照组比较，1)P < 0.05。 
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表 2 2组最大呼气压、最大吸气压时咽腔顺应性比较
组别 最大吸气压时
腭咽平面变化程度/%最大吸气压时
舌咽平面变化程度/%最大呼气压时
腭咽平面变化程度/%最大呼气压时
舌咽平面变化程度/%OSA组 -89.44±7.322) -58.23±7.192) 48.00±7.432) 32.71±7.351) 对照组 -54.16±7.96 -38.55±6.68 26.70±6.92 20.86±7.01 与对照组比较，1)P < 0.05；2)P < 0.01。
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表 3 正负压下腭咽、舌咽平面截面积变化程度
压力 腭咽平面截面积
变化程度/%舌咽平面截面积
变化程度/%正压 2 kPa 29.18±5.91 24.91±5.65 4 kPa 45.00±8.33 30.91±7.61 P 0.005 0.000 负压 -2 kPa -81.00±8.13 -52.00±6.28 -4 kPa -90.00±7.14 -59.45±7.12 P 0.008 0.020
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表 4 压力±2 kPa及最小负压时腭咽、舌咽平面截面积变化程度
压力 腭咽平面截面积
变化程度/%舌咽平面截面积
变化程度/%P -2 kPa -81.89±7.78 -52.76±5.97 0.000 2 kPa 28.43±6.42 23.69±5.42 0.004 最大吸气压 -89.44±7.32 -58.23±7.19 0.000
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