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___________应用MRI研究流体迁移对睡眠呼吸暂停患者上气道截面形状的影响_________

Using MRI to study effects of fluid shift on the cross-sectional shape of the upper airway in obstructive sleep apnea patients

作者:               王存亭  张菡  林洪义  许慧祥  胡歌  李铮  黄亚奇          
单位:&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;首都医科大学生物医学工程学院临床生物力学应用基础研究北京市重点实验室 (北京100069)<p></p>
关键词:           流体迁移;磁共振成像;气道截面形状;气道截面积;流动阻力      
分类号:&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;R318.04 &nbsp; &nbsp;
出版年·卷·期(页码):2016·35·1(31-35)
摘要:

目的 人体由站姿或坐姿变为睡眠时的卧姿时,流体受重力的影响自腿部向头颈部迁移,导致气道周围软组织体积增加,压强增大,从而挤压气道,导致睡眠过程中气道更易阻塞。本研究针对阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患者,分析流体迁移对上气道截面形状以及气道流动阻力的影响。方法 使用磁共振三维容积扫描方法,对受试者进行两种状态下的头颈部横断面成像:平卧参考状态以及双腿抬起持续8min流体重新分布状态。从选定横断面的图像上分析这两种状态下气道截面积以及形状的改变,并从水力学半径的角度分析不同类型的形变对气道流动阻力的影响。结果 相比于平卧参考状态时的气道截面形状,抬腿8min流体重新分布后气道截面积改变的同时,形状呈现出三种类型变化:气道截面形状基本不变;气道截面长短轴比例变大,截面形状趋于更扁;气道截面长短轴比例变小,截面形状趋向圆形。这些不同形式的形状改

变,可以对气道的阻力产生很大的影响。结论 体位改变引起的流体迁移除了改变气道截面积之外,还会

改变气道的截面形状,而截面形状的改变可对流动阻力产生重要影响。这一研究为深入探索OSA发生的机

制提供了研究基础。


Objective When body posture changes from standing or sitting to a recumbent 

posture at bedtime,fluid displaces from the lower body into the neck due to gravity,which

may increase the volume of the soft tissues surrounding the upper airway and tissue 

pressure. As a result,it may narrow the upper airway and increase the propensity of airway 

obstruction in patients with obstructive sleep apnea (OSA). The aim of this study is to 

analyze the effects of fluid shift on the shape of the airway cross section and flow 

resistance. Method Using three-dimensional spoiled gradient echo sequence,we perform 

magnetic resonance imaging (MRI) for OSA subjects under two conditions:with subjects lying supine (the control),and elevating both legs for 8min,which causes fluid redistribution. We analyze the changes in the cross-sectional area and shape of the upper airway using selected axial images,and evaluate the effects of different shape changes on the airway resistance based on hydraulic radius theory. Results Compared to the control stage,there are three types of shape changes in the cross-section of the upper airway after leg raising for 8min:the shape basically remains unchanged;the ratio of the major to minor axis 

increases,which means that the shape becomes more elliptical;and the ratio of the major to 

minor axis decreases,which means that the shape becomes more circular. The changes in the 

cross-sectional shape have significant effects on the flow resistance. Conclusions Fluid 

shift induced by posture change can change not only the cross-sectional area,but also the 

shape of the upper airway. The change in shape has significant effects on flow resistance. 

This study provides an important basis for further investigations on OSA mechanism. 


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