三维CT重建在肥胖OSAHS患者与正常人群上气道比较中的应用

doi:10.19438/j.cjoms.2021.06.012

摘要/Abstract

摘要： 目的通过三维CT(3D-CT) 重建技术,分析肥胖阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者与正常成人上气道的差异,并用于困难气道的预测。方法选择肥胖OSAHS患者及正常成人对照各31例,肥胖OSAHS患者美国麻醉师协会（ASA）分级Ⅱ级,年龄（34.33±10.07）岁（17~55岁）,BMI为（39.05±5.17）kg/m²。对照组ASA分级Ⅰ~Ⅱ级,年龄（28.34±6.41）岁（18~35岁）,BMI为（23.23±4.51）kg/m²。采用Mimics 11.04软件,分别对2组对象的上气道三维CT重建数据进行测量分析,得到包括气道最小横截面、气道体积等数据,比较困难气道患者与正常人咽气道三维形态的差异,采用SPSS 21.0软件包对数据进行统计学分析,评价困难气道患者上气道三维CT形态特征。结果困难气道患者上气道总体积、软腭后区体积及会厌后区体积与正常对照组相比均显著减小（P<0.05）,舌后区体积与正常对照组无显著差异（P>0.05）。结论 3D-CT重建测量可以明确上气道狭窄部位、严重程度,可作为较好的困难气道术前评估量化手段。

关键词: 困难气道, 三维CT重建, 肥胖, 睡眠呼吸暂停低通气综合征

Abstract: PURPOSE: To evaluate the upper airway condition more precisely by using three-dimensional CT reconstruction (3D-CT) in patients with difficult airway during preoperative assessment. METHODS: A total of 62 obese patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and normal adults were recruited. ASA grade Ⅱ of obese OSAHS patients was 34. 33± 10. 07 (17-55) years old, with a BMI of (39. 05±
5. 17)kg/m². In the control group, ASA grade Ⅰ to Ⅱ was 28. 34±6. 41 (18-35) years old, and the BMI was (23. 23±
4. 51)kg/m². Mimics 11. 04 was used to analyze the upper airway of OSAHS patients and normal people by reviewing the upper airway 3D-CT data which included the minimum area and the volume of the upper airway. Difference of the upper airway between OSAHS patients and normal ones in 3D-CT reconstruction was analyzed with SPSS 21. 0 software package. RESULTS: OSAHS patients' volume of total airway, retropalatal region and epiglottal region were significantly smaller than the controls (P< 0. 05). There was no significant difference in retroglossal region between OSAHS patients and the controls(P> 0. 05). CONCLUSIONS: 3D-CT reconstruction can display upper airway stenosis and is a good preoperative assessment of difficult airway.

Key words: Difficult airway, 3D-CT reconstruction, Obesity, Obstructive sleep apnea-hypopnea syndrome

中图分类号:

R782.2

王佳怡, 施巍, 胡蓉, 李静洁, 姜虹. 三维CT重建在肥胖OSAHS患者与正常人群上气道比较中的应用[J]. 中国口腔颌面外科杂志, 2021, 19(6): 549-552.

WANG Jia-yi, SHI Wei, HU Rong, LI Jing-jie, JIANG Hong. Application of 3D-CT reconstruction in comparison of upper airway between obese patients with obstructive sleep apnea-hypopnea syndrome and normal persons[J]. China J Oral Maxillofac Surg, 2021, 19(6): 549-552.

参考文献

[1] Crosby ET, Cooper RM, Douglas MJ, et al.The unanticipated difficult airway with recommendations for management[J]. Can J Anaesth, 1998, 45(8): 757-776.
[2] Todd DW.A comparison of endotracheal intubation and use of the laryngeal mask airway for ambulatory oral surgery patients[J]. J Oral Maxillofac Surg, 2002, 60(1): 2-4, 5.
[3] 姜虹, 黄燕, 朱也森. 围术期困难气道的危险因素及预测模型研究[J]. 中国临床医学, 2008, 15(4): 540-542.
[4] 刘锦星, 姜虹. 气道内仿真内镜的临床应用[J]. 医学综述, 2008, 14(2): 306-308.
[5] 刘锦星, 姜虹, 朱也森. 三维CT重建预测口咽肿瘤患者插管困难的价值[J]. 上海医学, 2009, 32(1): 29-33.
[6] 周驰, 朱也森, 姜虹,等. 用于困难插管气道预测的头影测量系统的建立[J]. 上海口腔医学, 2008, 17(4): 434-437.
[7] Zhang W, Si LY.Obstructive sleep apnea syndrome (OSAS) and hypertension: pathogenic mechanisms and possible therapeutic approaches[J]. Ups J Med Sci, 2012, 117(4): 370-382.
[8] Lienhart A, Auroy Y, Péquignot F, et al.Survey of anesthesia-related mortality in France[J]. Anesthesiology, 2006, 105(6): 1087-1097.
[9] Ney DR, Kuhlman JE, Hruban RH, et al.Three-dimensional CT-volumetric reconstruction and display of the bronchial tree[J]. Invest Radiol, 1990, 25(6): 736-742.
[10] Naidich DP, Gruden JF, McGuinness G, et al. Volumetric (helical/spiral) CT (VCT) of the airways[J]. J Thorac Imaging, 1997, 12(1): 11-28.
[11] Rubin GD, Napel S, Leung AN.Volumetric analysis of volumetric data: achieving a paradigm shift[J]. Radiology, 1996, 200(2): 312-317.
[12] Kitaoka H, Yumoto T.Three-dimensional CT of the bronchial tree. A trial using an inflated fixed lung specimen[J]. Invest Radiol, 1990, 25(7): 813-817.
[13] Tello R, Kruskal J, Dupuy D, et al.In vivo three-dimensional evaluation of the tracheobronchial tree[J]. J Thorac Imaging, 1995, 10(4): 291-293.
[14] Calloway HE, Kimbell JS, Davis SD, et al.Comparison of endoscopic versus 3D CT derived airway measurements[J]. Laryngoscope, 2013, 123(9): 2136-2141.
[15] Godoy MC, Saldana DA, Rao PP, et al.Multidetector CT evaluation of airway stents: what the radiologist should know[J]. Radiographics, 2014, 34(7): 1793-1806.
[16] Nair A, Godoy MC, Holden EL, et al.Multidetector CT and postprocessing in planning and assisting in minimally invasive bronchoscopic airway interventions[J]. Radiographics, 2012, 32(5): E201-E232.
[17] Hwang HS, Choe SY, Hwang JS, et al.Reproducibility of facial soft tissue thickness measurements using cone-beam CT images according to the measurement methods[J]. J Forensic Sci, 2015, 60(4): 957-965.
[18] Bianchi A, Muyldermans L, Di Martino M, et al.Facial soft tissue esthetic predictions: validation in craniomaxillofacial surgery with cone beam computed tomography data[J]. J Oral Maxillofac Surg, 2010, 68(7): 1471-1479.
[19] Chen H, Aarab G, Parsa A, et al.Reliability of three-dimensional measurements of the upper airway on cone beam computed tomography images[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2016, 122(1): 104-110.
[20] Chen X, Sun J, Yuan W, et al.OSAHS obstructive plane localization: comparative study between ag200 and friedman classification[J]. Int J Clin Exp Med, 2015, 8(2): 2240-2246.
[21] Singh A, Al-Reefy H, Hewitt R, et al.Evaluation of ApneaGraph in the diagnosis of sleep-related breathing disorders[J]. Eur Arch Otorhinolaryngol, 2008, 265(12): 1489-1494.
[22] Schwab RJ, Gupta KB, Gefter WB, et al.Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls[J]. Am J Respir Crit Care Med, 1995, 152(5 Pt 1): 1673-1689.
[23] Patino M, McAuliffe J, Francis L, et al. Obstructive sleep apnea syndrome: anesthetic concerns[J]. Int Anesthesiol Clin, 2012, 50(4): 41-53.