Isono Shiroh, Tanaka Atsuko, Tagaito Yugo, Ishikawa Teruhiko, Nishino Takashi
Department of Anesthesiology (B1 Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, 260-8670, Japan.
J Appl Physiol (1985). 2004 Jul;97(1):339-46. doi: 10.1152/japplphysiol.00907.2003. Epub 2004 Mar 12.
A collapsible tube surrounded by soft material within a rigid box was proposed as a two-dimensional mechanical model for the pharyngeal airway. This model predicts that changes in the box size (pharyngeal bony enclosure size anatomically defined as cross-sectional area bounded by the inside edge of bony structures such as the mandible, maxilla, and spine, and being perpendicular to the airway) influence patency of the tube. We examined whether changes in the bony enclosure size either with head positioning or bite opening influence collapsibility of the pharyngeal airway. Static mechanical properties of the passive pharynx were evaluated in anesthetized, paralyzed patients with sleep-disordered breathing before and during neck extension with bite closure (n = 11), neck flexion with bite closure (n = 9), and neutral neck position with bite opening (n = 11). Neck extension significantly increased maximum oropharyngeal airway size and decreased closing pressures of the velopharynx and oropharynx. Notably, neck extension significantly decreased compliance of the oropharyngeal airway wall. Neck flexion and bite opening decreased maximum oropharyngeal airway size and increased closing pressure of the velopharynx and oropharynx. Our results indicate the importance of neck and mandibular position for determining patency and collapsibility of the passive pharynx.
有人提出，将一个置于刚性盒内、由柔软材料包裹的可折叠管作为咽气道的二维力学模型。该模型预测，盒尺寸的变化（咽骨包围结构的尺寸，在解剖学上定义为以下颌骨、上颌骨和脊柱等骨结构内边缘为界且垂直于气道的横截面面积）会影响管的通畅性。我们研究了头部位置改变或张口时骨包围结构尺寸的变化是否会影响咽气道的可塌陷性。在睡眠呼吸障碍的麻醉、麻痹患者中，于咬口闭合时颈部伸展（n = 11）、咬口闭合时颈部屈曲（n = 9）以及咬口张开时颈部处于中立位置（n = 11）的情况下，评估被动咽部的静态力学特性。颈部伸展显著增加了口咽气道的最大尺寸，并降低了软腭咽和口咽的闭合压力。值得注意的是，颈部伸展显著降低了口咽气道壁的顺应性。颈部屈曲和张口会减小口咽气道的最大尺寸，并增加软腭咽和口咽的闭合压力。我们的结果表明，颈部和下颌位置对于确定被动咽部的通畅性和可塌陷性具有重要意义。
