北京生物醫(yī)學(xué)工程

阻塞性睡眠呼吸暫停患者體位改變致流體向頭頸部遷移的研究

Process of rostral fluid shift induced by body posture changes in obstructive sleep apnea patients

作者：張菡王存亭林洪義許慧祥黃亞奇

單位：首都醫(yī)科大學(xué)生物醫(yī)學(xué)工程學(xué)院臨床生物力學(xué)應(yīng)用基礎(chǔ)研究北京市重點(diǎn)實(shí)驗(yàn)室 (北京100069)

分類號：R318.04

出版年·卷·期（頁碼）：2016·35·1（36-40）

摘要：

目的當(dāng)人體由立姿或坐姿改變?yōu)樗邥r的臥姿時,下肢流體會向頭頸部遷移,使得上氣道變窄。研究體位改變時阻塞性睡眠呼吸暫停（obstructive sleep apnea,OSA）患者頭頸部組織中流體重新分布的過程，對于理解流體遷移在OSA患者氣道阻塞上扮演的角色具有重要的意義。本研究通過測量OSA重度患者隨著體位改變，在不同時刻腿部流體量，以及頸部和腿部幾何參量，驗(yàn)證遷移流體量隨時間非線性變化的假設(shè)。方法對于9名睡眠呼吸暫停低通氣指數(shù)AHI > 30的重度患者，進(jìn)行整夜多導(dǎo)睡眠監(jiān)測，記錄睡眠狀態(tài)及AHI的變化，并測量站立、剛剛仰臥、仰臥15min，及早上起床前仰臥諸時刻的腿部流體量以及頸圍、腿圍、踝圍等幾何參量，分析遷移流體量隨時間的變化規(guī)律。結(jié)果由立姿改為仰臥后，幾乎有總遷移量1/5的流體立刻發(fā)生遷移；仰臥15min后遷移量升至1/3。睡眠監(jiān)測顯示受試者進(jìn)入睡眠時間為(30.1 ± 18.3)min。通過數(shù)據(jù)曲線擬合可推算出，仰臥30min后流體遷移量將升至總遷移量的1/2。結(jié)論在OSA重度患者中，體位改變后，向頭頸部遷移的流體量隨時間以強(qiáng)非線性規(guī)律變化。相比于整夜的流體遷移量，在患者進(jìn)入睡眠前，主要的流體遷移過程已基本完成。

Objective When the body posture changes from standing or sitting to supine position,the fluid in the lower body will shift into the head and neck,resulting in upper airway narrowing. Investigating the process of fluid redistribution in the soft tissues of the head and neck resulting from posture changes is important for understanding the role played by fluid shift in airway obstruction in obstructive sleep apnea (OSA) patients. In this study,we measure the leg fluid volume and geometrical parameters of the neck and legs in patients with severe OSA at different times to test our hypothesis that the amount of fluid shifted into the head and neck changes nonlinearly with time. Methods Overnight polysomnography is performed in 9 patients with apnea-hypopnea index AHI > 30 to monitor sleep stages and AHI changes. Neck,calf and ankle circumferences at standing,right after lying down,lying supine for 15min,and before rising in the morning are measured to analyze the process of fluid shift with time. Results Almost 20 percent of the total amount of displaced fluid shifts immediately after the body posture changes from standing to supine position. This value increases to one third of the total fluid displacement after lying supine for 15min. Polysomnography data show that the time between lying down and sleep onset in OSA subjects is (30.1 ± 18.3)min. We can predict from data fitting that the amount of fluid shift after lying supine for 30min may increase to 50% of the total amount of displaced fluid. Conclusions The amount of fluid shifted into the head and neck changes nonlinearly with time. Compared to the total amount of fluid shift during the whole night,the major process of fluid shift has largely finished before sleep onset in these OSA patients.

參考文獻(xiàn)：

［1］Shiota S,Ryan CM,Chiu KL,et al. alterations in upper airway cross-sectional area in response to lower body positive pressure in healthy subjects［J］. Thorax. 2007,62(10):868-872.

［2］Chiu K,Ryan CM,Shiota S,et al. Fluid shift by lower body positive pressure increases pharyngeal resistance in healthy subjects［J］. American Journal of Respiratory and Critical Care Medicine,2006,174(12):1378-1383.

［3］Su M,Chiu K,Ruttanaumpawan P,et al. Lower body positive pressure increases upper airway collapsibility in healthy subjects［J］. Respiratory Physiology & Neurobiology, 2008,161(3):306-312.

［4］Redolfi S,Yumino D,Ruttanaumpawan P,et al. Relationship between overnight rostral fluid shift and obstructive sleep apnea in nonobese men［j］. American Journal of Respiratory and Critical Care Medicine，2009,179(3):241-246.

［5］張馨月，黃亞奇. 定量研究流體遷移對上氣道形態(tài)影響的有限元模型方法［J］.北京生物醫(yī)學(xué)工程，2014,33(1):1-6.

Zhang Xinyue,Huang Yaqi. A finite element modeling method for quantitatively investigating the effects of fluid shift on the upper airway patency［J］.Beijing Biomedical Engineering,2014,33(1):1-6.

［6］Jafari B,Mohsenin V. Overnight rostral fluid shift in obstructive sleep apnea［J］. Chest Journal，2011,140(4):991.

［7］李永，安云強(qiáng)，劉兆會，等. 磁共振三維容積成像用于流體遷移對上氣道形態(tài)影響研究［J］. 北京生物醫(yī)學(xué)工程，2013,32(2):139-142,205.

Li Yong，An Yunqiang，Liu Zhaohui，et al. A 3D volume MRI method for studying the effect of fluid shift on the upper airway patency［j］.Beijing Biomedical Engineering,2013,32(2):139-142,205.

［8］An Y,Li Y,Liu Z,et al. Effects of fluid shift on upper airway patency and neck circumference in normal weight subjects［J］. Sleep Medicine, 2015,14:1419-1426.

［9］Yadollahi A,Singh B,Bradley TD. Investigating the dynamics of supine fluid redistribution within multiple body segments between men and women［J］. Annals of Biomedical Engineering,2015,43(9):2131-2142.

服務(wù)與反饋：

【文章下載】【加入收藏】

提示：您還未登錄，請登錄！點(diǎn)此登錄

51黑料吃瓜在线观看,51黑料官网|51黑料捷克街头搭讪_51黑料入口最新视频