本文選題：阻塞性睡眠呼吸暫停綜合征　切入點(diǎn)：頸動(dòng)脈　出處：《南京醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：(1)通過血管超聲動(dòng)脈僵硬度定量分析(quantitative arterial stiffness, QAS)技術(shù)探討阻塞性睡眠呼吸暫停綜合征(obstructive sleep apnea syndrome, OSAS)患者頸動(dòng)脈彈性參數(shù)的變化特征及臨床意義。(2)運(yùn)用血管超聲探討阻塞性睡眠呼吸暫停綜合征與早期動(dòng)脈粥樣硬化間的相互關(guān)系。 方法：阻塞性睡眠呼吸暫停綜合征患者72例,根據(jù)有無合并高血壓分為OSAS無高血壓組(OSAS1組)37例及OSAS合并高血壓組(OSAS2組)35例,40例同期健康志愿者為對照組。運(yùn)用QAS技術(shù)測量頸動(dòng)脈各項(xiàng)彈性參數(shù),包括血管擴(kuò)張度(vascular expansibility, VE)、順應(yīng)性系數(shù)(compliance coefficient, CC)、僵硬度系數(shù)(stiffness index, β)、脈搏波傳播系數(shù)(pulse wave velocity, PWV),分析三組上述指標(biāo)間的差別。并用多導(dǎo)睡眠呼吸監(jiān)測(polysomnograph, PSG)測得OSAS組的睡眠吸暫停低通氣指數(shù)(apnea-hypopnea index, AHI)和最低脈氧飽和度(minimal pulse oxyhemoglobin saturation, miniSpO2)、氧飽和度低于90%時(shí)間占監(jiān)測時(shí)間的百分比(time spent below oxygen saturation of90%, Ts90%)、氧減指數(shù)(oxygen desaturation index, ODI)等血氧飽和度相關(guān)指標(biāo),并將其與PWV之間進(jìn)行相關(guān)回歸分析。 結(jié)果：(1)與正常對照組相比,OSAS1和OSAS2組的頸動(dòng)脈彈性系數(shù)VE、CC明顯降低,而β值及PWV明顯升高(P0.05)。與OSAS1組相比較,OSAS2組CC值降低,β值及PWV升高(P0.05)。(2)應(yīng)用Pearson相關(guān)分析發(fā)現(xiàn)病例組PWV與收縮壓、AHI、ODI、年齡呈正相關(guān)(r=0.285-0.542,P均0.05),通過多元線性回歸分析顯示病例組中年齡、ODI是PWV的獨(dú)立預(yù)測因素。 結(jié)論：OSAS患者早期就存在動(dòng)脈彈性功能減退,合并高血壓后損傷更明顯,應(yīng)用QAS技術(shù)能夠準(zhǔn)確分析頸動(dòng)脈彈性功能,對評價(jià)早期動(dòng)脈粥樣硬化具有一定的臨床價(jià)值。 目的：(1)評價(jià)經(jīng)連續(xù)氣道內(nèi)正壓通氣治療后對阻塞性睡眠呼吸暫停(OSAS)患者血管彈性及內(nèi)皮功能的影響。 方法：選取不合并高血壓的OSAS患者37例,以及40例同期健康志愿者作為對照組。運(yùn)用動(dòng)脈僵硬度分析(QAS)技術(shù)測量頸動(dòng)脈各項(xiàng)彈性參數(shù),包括血管擴(kuò)張度(VE)、順應(yīng)性系數(shù)(CC)、僵硬度系數(shù)(β)、脈搏波傳播系數(shù)(PWV),應(yīng)用血管超聲內(nèi)皮功能檢測方法測得肱動(dòng)脈血流介導(dǎo)的血管擴(kuò)張性(flow-mediated dilation, FMD),分析兩組上述指標(biāo)間的差別。并用多導(dǎo)睡眠呼吸監(jiān)測(PSG)測得OSAS組的睡眠呼吸暫停低通氣指數(shù)(AHI)和最低脈氧飽和度(miniSpO2)等血氧飽和度相關(guān)指標(biāo),與FMD值之間進(jìn)行相關(guān)回歸分析。對OSAS組中的20例患者進(jìn)行持續(xù)氣道內(nèi)正壓(continuous positive airway pressure, CPAP)治療,并分析治療3個(gè)月前后各項(xiàng)參數(shù)的改變。 結(jié)果：(1)與正常對照組相比,OSAS組的FMD值降低(P0.05)。(2) OSAS組中肱動(dòng)脈FMD值與AHI、年齡、β呈負(fù)相關(guān)(r=-0.325～-0.378、P均0.05),與miniSpO2呈正相關(guān)(r=0.504,P0.01),通過多元線性回歸分析顯示病例組中miniSpO2是FMD的獨(dú)立預(yù)測因素(R2=0.548,P0.05)。(3)與治療前相比,治療3個(gè)月后FMD值及頸動(dòng)脈彈性系數(shù)CC明顯上升,而p值及PWV下降顯著(P0.05)。 結(jié)論：血管超聲可發(fā)現(xiàn)OSAS患者早期就存在內(nèi)皮損傷及彈性功能減退,同時(shí)CPAP治療能夠有效的改善患者血管彈性及內(nèi)皮功能。
[Abstract]:Objective: (1) by vascular ultrasound quantitative analysis of arterial stiffness (Quantitative arterial stiffness, QAS) on obstructive sleep apnea syndrome (obstructive sleep apnea syndrome, OSAS) variation of carotid artery elasticity parameters of patients and clinical significance. (2) the use of ultrasound to obstructive sleep apnea syndrome the relationship between the early atherosclerosis.
Methods: obstructive sleep apnea syndrome patients 72 cases, according to whether the patients have hypertension were divided into OSAS group without hypertension (OSAS1 group) and 37 cases of OSAS with hypertension group (OSAS2 group) 35 cases and 40 healthy volunteers as control group. The use of the QAS technology to measure carotid elastic parameters, including blood vessels expansion ratio (vascular expansibility, VE), compliance coefficient (compliance coefficient, CC), stiffness coefficient (stiffness index, beta), pulse wave propagation coefficient (pulse wave velocity, PWV), analysis of three groups of the above indexes. And the difference between using polysomnography (polysomnograph, PSG) test OSAS group of sleep apnea hypopnea index (apnea-hypopnea, index, AHI) and the lowest pulse oxygen saturation (minimal pulse oxyhemoglobin saturation, miniSpO2), oxygen saturation of less than 90% percentage of the time monitoring time (time spent below oxygen SA Turation of90%, Ts90%), oxygen subtraction index (oxygen desaturation index, ODI) and other related indexes of blood oxygen saturation, and to carry out a correlation regression analysis between PWV and PWV.
Results: (1) compared with the normal control group, the coefficient of elasticity of carotid artery VE OSAS1 and OSAS2 group, CC decreased significantly, while beta and PWV increased significantly (P0.05). Compared with OSAS1 group, OSAS2 group, CC decreased, the beta value and increase of PWV (P0.05). (2) by Pearson the analysis found that PWV in patients with systolic blood pressure, AHI, ODI, was positively correlated with age (r=0.285-0.542, P < 0.05), through multiple linear regression analysis showed that age in the case group, ODI are independent predictors of PWV.
Conclusion: there is early arterial elasticity decline in OSAS patients, and it is more obvious after hypertension. QAS technology can accurately analyze carotid elasticity and has certain clinical value in evaluating early atherosclerosis.
Objective: (1) to evaluate the effects of continuous positive airway pressure (CV) therapy on vascular elasticity and endothelial function in patients with obstructive sleep apnea (OSAS).
Methods: a total of 37 OSAS patients with hypertension patients and 40 healthy volunteers as control group. The arterial stiffness (QAS) technique for measuring the carotid elastic parameters, including vascular dilation (VE), compliance coefficient (CC), stiffness coefficient (beta), pulse wave propagation coefficient (PWV), vascular dilatation of brachial artery flow mediated endothelial function testing method using blood vessel ultrasound (flow-mediated dilation, FMD), analysis the differences of the parameters between two groups. And polysomnography (PSG) measured in group OSAS sleep apnea hypopnea index (AHI) and the lowest pulse oxygen saturation (miniSpO2) and oxygen saturation index, regression analysis and FMD value. In 20 cases of patients in OSAS group were continuous positive airway pressure (continuous positive airway pressure, CPAP) treatment and analysis before and after treatment for 3 months each Changes in the parameters of the item.
Results: (1) compared with the normal control group, OSAS group, FMD decreased (P0.05). (2) FMD of the brachial artery in group OSAS and AHI, age was negatively related to beta (r=-0.325 ~ -0.378, P 0.05), was positively correlated with miniSpO2 (r=0.504, P0.01), through multiple linear regression the analysis shows that miniSpO2 in the case group is an independent predictor of FMD (R2=0.548, P0.05). (3) compared with before treatment, after 3 months of treatment, FMD value and elasticity of carotid CC increased obviously, and the value of P and PWV decreased significantly (P0.05).
Conclusion: vascular ultrasound can detect endothelial damage and decrease in elastic function in early stage of OSAS. Meanwhile, CPAP can effectively improve vascular elasticity and endothelial function in patients.

【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R56

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本文編號(hào)：1568799