CT测量对阻塞性睡眠呼吸暂停综合征患者舌咽区气道阻塞诊断意义的再评估

目的以置入鼻咽通气管后的多导睡眠呼吸监测（NPT-PSG）结果判定中重度阻塞性睡眠呼吸暂停综合征（OSAHS）患者舌咽区气道阻塞情况，并与螺旋CT的判定结果对比，评估CT扫描测量在舌咽区上气道阻塞判定中的作用。方法经PSG检查确诊的中重度OSAHS患者65例，在鼻咽通气管置入后再次进行NPT．PSG，同时采用螺旋CT对上呼吸道进行连续扫描。就NPT-PSG结果与CT扫描测量所得的舌咽区气道截面积进行相关性分析，并以睡眠呼吸暂停低通气指数（AHI）≥15次/h和舌咽区气道截面积〈181mm^2为参考标准判定舌咽区气道是否存在狭窄或阻塞，比较两种判定方法结果的异同。结果NPT-PSG所得AHI和最低血氧饱和度（LSaO2）与舌咽区气道截面积无明显相关性，相关系数分别为O．02和0．085，P均〉0．05。舌咽区气道截面积〈181mm^2提示舌咽狭窄者7例，无明显狭窄的例数为58例；NPT-PSG所得AHI≥15次/h提示舌咽区气道阻塞者37例，无明显阻塞者28例。以统计量kappa系数评价两种测量结果的一致性，Kappa系数为0．055，P〉0．05，两者一致性较差。结论螺旋CT测量和NPT-PSG判定舌咽区气道狭窄或阻塞一致性较差，临床判定舌咽区气道阻塞与否应结合多种方法综合判定。

Diagnosis value assessment of computered tomography in glossopharyngeal obstruction in obstructive sleep apnea hypopnea syndrome.

Objective To compare NPT-PSG with computered tomography （CT） scan which was also used to evaluate the glossopharyngeal obstruction. Methods Sixty-five patients with OSAHS diagnosed by PSG were enrolled in this study. All the patients were successfully examined by NPT-PSG and CT scan. The correlation analysis between NPT PSG and glossopharyngeal airway cross area （S） were conducted. And the coincidence of diagnosing glossopharyngeal obstruction of the two methods was calculated. Results There was no significant correlation between NPT-PSG and glossopharyngeal airway cross area, the correlation coefficient of AHI and LSaO2 with S was 0.02 and 0.085 respec tively. There were 7 and 37 patients diagnosed as glossopharyngeal obstruction by CT and NFr-PSG respectively. The concordance of the two methods was poor, assessed by kappa coefficient 0.055, P 〉 0.05. Conclusion The coinci dence between the CT scan and NFF-PSG is poor. Multiple diagnosis tool and aggregate analysis should be used in lo calization glossopharyngeal obstruction in OSAHS.