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目的对睡眠状态下的阻塞性睡眠呼吸暂停综合征(OSAS)患者行低剂量动态多层螺旋CT(MSCT)扫描,分析睡眠状态下气道实际阻塞或狭窄的部位、累及范围及动态变化,以修正静态气道测量的不精确性。方法16例OSAS患者分别行清醒平和呼吸状态下(简称清)与睡眠状态吸气末相(简称吸)、睡眠状态呼气末相(简称呼)下低剂量MSCT扫描,并于睡眠吸气末状态下气道最狭窄处行动态电影扫描。以睡眠吸气末状态下软腭后区(RP)、舌后区(RG)气道最狭窄处及会厌后区(EPG)会厌尖下5 mm处为3种状态下的测量层面,比较3种状态下咽腔各层面的测量值并记录各期相气道最狭窄的具体部位。结果RP区气道最小横截面积(XSA)(M清=47．50 mm2,M呼= 73.00 mm3,M吸=2.00 mm2;Z清呼=2．897,P清呼=0．003;Z清吸=4．192,P清吸<0．01;Z吸呼=4．538, P吸呼<0．01)的测量结果在3种状态下差异均有统计学意义;RP区前后径(AP)(M清=8．00 mm, M呼:9．50 mm,M吸=1．50 mm;Z清呼=1．933,P清呼=0．056;Z清吸=3．720,P清吸<0．01;Z吸呼=4．230, P吸呼<0．01)、左右径(LR)(M清=8．00 mm,M呼=9．00 mm,M吸=1．00 mm;Z清呼=1．210,P清呼= 0．246;Z清吸=4．203,P清吸<0．01;Z吸呼=4．557,P吸呼<0．01)、RP区气道体积(M清=4．00 mm3,M呼= 5．50 mm3,M吸=1．50 mm3;Z清呼=1．576,P清呼=0．125;Z清吸=3．532,P清吸<0．01;Z吸呼=4．077, P吸呼<0．01),RP(M清=7．00 mm,M呼=6．00 mm,M吸=10．50 mm;Z清呼=0．557,P清呼=0．603;Z清吸= 2．541,P清吸=0．011;Z吸呼=2．852,P吸呼=0．004)、RG(M清=5．00mm,M呼=3．00 mm,M吸=9．50 mm; Z清呼=0．747,P清呼=0．482;Z清吸=2．657,P清吸=0．007;Z吸呼=3．075,P吸呼=0．001)区咽后壁至椎体前缘垂直距离的测量结果,睡眠吸气末相与清醒或睡眠呼气末相差异有统计学意义。睡眠状态下动态电影扫描可直观、清晰地显示咽腔的形态学变化。结论(1)睡眠吸气末相对OSAS患者咽腔狭窄或闭塞的CT定位是最精确的,可明显降低清醒状态下测量的假阴性。(2)低剂量MSCT可明显减少对患者的放射剂量。
Objective To perform low-dose dynamic multi-slice spiral CT (MSCT) scanning in patients with obstructive sleep apnea-hypopnea syndrome (OSAS) under sleep condition, to analyze the actual occlusion or narrowing of airway in sleep state, the extent and dynamic changes involved Correct static airway measurement inaccuracies. Methods Sixteen patients with OSAS underwent mild and moderate respiratory conditions (referred to as clean) and sleep state inspiratory phase (referred to as suction), sleep state exhaled end phase (referred to as call) low-dose MSCT scan, State of the narrowest airway dynamic film scanning line. In the sleep apnea (RP), the narrowest airway of the posterior lingual region (RG) and the epicardium (EPG), the apical foci of 5 mm were measured at three different levels. State pharynx various levels of measurement and record the most narrow phase of the specific parts of the airway. Results The minimum cross-sectional area (XSA) of airway in RP area (M = 47.50 mm2, M = 73.00 mm3, M = 2.00 mm2, Z = 2.897, 4.192, P desorption <0.01; Z breath = 4.538, P breath <0.01) in the three kinds of measurement results were statistically significant differences; RP before and after the diameter (AP = M = 8.00 mm, M = 9.50 mm, M = 1.50 mm; Z = 1.933, P = 0.056; 720, P siphon <0.01; Z siphon = 4.230, P siphon <0.01), LR (M = 8.00 mm, M = 9.00 mm, M Absorption = 1.00 mm; Z Clearance = 1.210, P Clearance = 0.246; Z Clearance = 4.203, P Clearance <0.01; Z Absorption = 4.557, P Absorption <0.01). The volume of airway in RP area (M = 4.00 mm3, M = 5.50 mm3, M = 1.50 mm3; Z = 1.576 and P = 0. 125; Z seizure = 3.532, P seizure <0.01; Z seizure = 4.077, P seizure <0.01), RP (M = 7.00 mm, M = 6. 00 mm, M = 10.50 mm; Z = 0.557, P = 0.603; Z = 2.541, P = 0.011; Z = 2.852 , P breath = 0.004), RG (M = 5.00 mm, M = 3.00 mm, M = 9.50 mm; Z = 0.747 and P = 0.482 ; Z-smoked = 2.657, P-smoked = 0.007; Z-smoked = 3.07 5, P breath = 0.001) measured the posterior wall of the pharyngeal anterior vertebral vertical distance measurements, sleep apnea and awake or end-expiratory sleep phase were statistically significant. Dynamic cine scans during sleep can visually and clearly show the morphological changes in the pharynx. Conclusions (1) The CT location of the aspirate at the end of sleep compared with OSAS patients with stenosis or occlusion of the pharyngeal cavity is the most accurate and can significantly reduce the false negatives measured in the awake state. (2) Low-dose MSCT can significantly reduce the patient’s radiation dose.