·论著·阻塞性睡眠呼吸暂停患者临床表现与上气道阻塞部位关系的探讨费忠亭1,张希龙2△【摘要】目的观察一组AHI接近的阻塞性睡眠呼吸暂停综合征(OSAS)患者中上气道阻塞部位对多导睡眠监测(PSG)图及临床表现的影响。方法选取36例AHI为30～40的成年男性OSAS患者行再次整夜PSG,加同步上气道及食道压力监测确定上气道最低阻塞部位。比较上气道最低阻塞部位在软腭水平、舌根水平和下咽水平的不同患者中PSG相关参数:平均SaO2、最低SaO2、最长阻塞性呼吸暂停事件时间、呼吸暂停事件中SaO2下降率(dSaO2/dt)、微觉醒指数;以及部分临床表现参数:白日嗜睡程度、入睡前收缩压/清晨收缩压、入睡前舒张压/清晨舒张压以及高血压发生率。结果平均SaO2、最长阻塞性呼吸暂停事件时间和入睡前收缩压/清晨收缩压比值在3种不同上气道最低阻塞部位患者中差异无显著性(P>0.05),但与软腭水平相比,舌根水平和下咽水平的最低SaO2降低(P>0.05),dSaO2/dt(%/s)比值增高(P<0.05),微觉醒指数及白日嗜睡评分增高(P<0.01),入睡前舒张压/清晨舒张压比值降低(P<0.05),最低SaO2<80%的发生率增高(P<0.01)以及高血压的发生率增高(P<0.01)。结论AHI接近的OSAS患者上气道阻塞部位在舌根水平以下者与软腭以上水平者相比,阻塞性呼吸暂停事件的致缺氧效率和程度提高,OSAS的临床表现加重。【关键词】阻塞性睡眠呼吸暂停;多导睡眠图;氧饱和度【中图分类号】R564【文献标识码】A【文章编号】1684-2030(2007)10-0870-04InvestigationonassociationbetweenclinicalmanifestationsandobstructivesitesofupperairwayinpatientswithobstructivesleepapneaFEIZhong-ting,ZHANGXi-long.DepartmentofRespiratoryMedicine,ThePeople’sHospitalofGuannan,Jiangsu222500,China【Abstract】ObjectiveToinvestigatetheeffectsofupperairwayobstructionsitesonpolysomnographicpa2rametersandclinicalmanifestationsinpatientswithobstructivesleepapneasyndrome(OSAS).Methods36adultmaleOSASpatientswiththeirAHIbetween30～40wereselectedtoundergoovernightPSGtestandsimul2taneouspressuremeasurementofupperairwayandesophagusforidentificationofthelowestupperairwayob2structionsites.Comparisonwasmadeamongdifferentobstructionsites(sitesofsoftpalate,tongue-baseandlowerpharynx)forthefollowingparameters:nocturnalmeanarterialoxyhemoglobinsaturation(meanSaO2)andminimalSpO2(miniSaO2),thelongestobstructiveapneaeventtime,rateoffallofSaO2(dSaO2/dt),arousalindex;aswellassomeclinicalmanifestations:day-timesleepinessscale,systolicbloodpressure(SBP)at9:00PM/SBPat6:00AM,diastolicBP(DBP)at9:00PM/DBPat6:00AMandincidencesofhypertension.ResultsTherewasnosignificantdifferenceofmeanSpO2,thelongestobstructiveapneaeventtimeandSBPat9:00PM/SBPat6:00AM(P>0.05)amongthreedifferentlowestobstructionsitesinOSASpatients.Howev2er,comparedwiththeobstructivesiteatpalate,theobstructionsitesattongue-baseandlowerpharynxdis2playedsignificantdifferenceinthefollowingPSGandclinicalparameters:lowerminiSaO2(P<0105),higherdSaO2/dt(P<0.05),higherarousalindexandday-timesleepinessscale(P<0.01),lowerDBPat9:00PM/DBPat6:00AM.(P<0.05),higherincidenceofminiSaO2<80%andhypertension(allP<0.01).Con2clusionInOSASpatientswithsimilarAHI,thelowestupperairwayobstructionsiteattongue-baseorlowerpharnxmaycausetransienthypoxiamoreefficientlyandsignificantlyaswellasmoresevereclinicalmanifesta2tionsthanthesiteatpalateorhigher.【Keywords】obstructivesleepapnea;polysomnography;oxyhemoglobinsaturation作者单位:1222500江苏灌南,灌南县人民医院呼吸科2210029江苏南京,南京医科大学第一附属医院呼吸科(△通讯作者)·078·中华医学实践杂志ChineseJournalofPracticeMedicine2007年第6卷第10期睡眠期间歇性上气道阻塞和缺氧是阻塞性睡眠呼吸暂停综合征(OSAS)的基本病理特征。由于上气道...
