本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + AHI�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2012年碩士論文

【摘要】：背景：1、目前評估阻塞性睡眠呼吸暫停低通氣綜合征(Obstructive Sleep Apnea Hypopnea Syndrome, OSAHS)患者睡眠期間低氧嚴(yán)重程度的指標(biāo)最常用的有最低血氧飽和度(L02)、氧減指數(shù)(Oxygen Desaturation Index, ODI)、血氧飽和度低于90%占整個記錄時間的百分比(T90%)等。但它們只能反應(yīng)患者低氧的某一方面,無法反應(yīng)缺氧嚴(yán)重程度的全貌。2、多導(dǎo)睡眠圖(polysomnography, PSG)是診斷阻塞性睡眠呼吸暫停低通氣綜合征的金標(biāo)準(zhǔn)。但操作復(fù)雜,費用高,需要在睡眠實驗室進行,不易普及。國外部分學(xué)者認為夜間血氧監(jiān)測可初步代替PSG對高危患者行初篩檢查,但具體選用那些參數(shù)目前尚有爭議。 目的：研究兩項新指標(biāo)血氧飽和度近似熵(ApEn)和血氧受損時間指數(shù)(Saturation Impairment Time index, SITi)對于評估OSAHS患者睡眠期間低氧嚴(yán)重程度及診斷OSAHS的意義,并與其他參數(shù)行相關(guān)性分析,評價其臨床價值。 方法：回顧性分析500位疑診為OSAHS的患者。所有研究對象均記錄人體測量學(xué)資料、6小時睡眠呼吸監(jiān)測,以AHI為標(biāo)準(zhǔn)將研究對象分為正常對照、輕度、中度、重度4個亞組。1、分別比較4組中ApEn及SITi數(shù)值大小,并將其與AHI行相關(guān)性分析。此外,對ApEn、SITi與ODI、LO2、T90%行相關(guān)性分析。2、依據(jù)AHI為金標(biāo)準(zhǔn)應(yīng)用ROC曲線分析及約登指數(shù)明確ApEn、SITi對于診斷OSAHS及評估低氧程度的意義。統(tǒng)計學(xué)分析應(yīng)用SPSS16.0軟件進行。 結(jié)果：500名研究對象包括男性361例(72.2%),女性139例(27.8%),平均年齡53.2±15.2歲(范圍24-95歲)。1、ApEn、SITi在各個組間均有顯著性差異(P0.001),隨AHI增高,ApEn、SITi數(shù)值增大。進一步行兩兩組間比較發(fā)現(xiàn)ApEn在各個組間存在顯著性差異(P0.001), SITi除在正常對照與輕度OSAHS組間外在其他組間均存在顯著差異(P0.05)。Spearman(?)目關(guān)分析顯示ApEn、SITi與AHI呈正相關(guān)(相關(guān)系數(shù)R=0.765及R=0.678, P0.01)。 ApEn、SITi與ODI、LO2、T90%存在較好的相關(guān)性。根據(jù)ROC曲線分析結(jié)果,ApEn值16.70、17.81、20.03可分別作為判斷OSAHS患者缺氧輕度、中度、重度的界值,相應(yīng)SITi的取值為3.685、4.055、4.445。2、依據(jù)PSG AHI≥5作為金標(biāo)準(zhǔn),根據(jù)ROC分析結(jié)果求最佳診斷界值,在ApEn值取16.70時,其診斷OSAHS的敏感性達到69.5%,特異性達到90.3%。 結(jié)論：1、ApEn、SITi隨OSAHS患者病情加重數(shù)值明顯增大,與AHI、ODI、 LO2、T90%等存在一定的相關(guān)性,ApEn、SITi對于評價OSAHS低氧嚴(yán)重程度方面具有臨床價值。2、對于高危人群,可將ApEn作為診斷OSAHS的初篩。
[Abstract]:Background: 1, the most commonly used indicators to assess the severity of hypoxia during sleep in patients with obstructive sleep Apnea Hypopnea Syndrome (OSAHS) are minimum oxygen saturation (L02), oxygen Desaturation Index (ODI), and oxygen saturation (OSAHS). Less than 90% of the total recorded time (T 90%), etc. However, they can only reflect one aspect of hypoxia in patients, not the full picture of the severity of hypoxia. Polysomnography (PSG) is the gold standard for diagnosis of obstructive sleep apnea hypopnea syndrome (OSAS). But the operation is complicated, the cost is high, needs to carry on in the sleep laboratory, is not easy to popularize. Some foreign scholars think that nocturnal blood oxygen monitoring can replace PSG in primary screening of high-risk patients, but the selection of these parameters is still controversial. Objective: to study the significance of approximate entropy of blood oxygen saturation (ApEn) and Saturation injury time index (siti) in evaluating the severity of hypoxia during sleep and in diagnosing OSAHS in OSAHS patients, and to analyze the correlation with other parameters. To evaluate its clinical value. Methods: 500 suspected OSAHS patients were analyzed retrospectively. All subjects recorded anthropometric data for 6 hours of sleep apnea monitoring. According to AHI, the subjects were divided into 4 subgroups: normal control, mild, moderate and severe. The values of ApEn and siti were compared among the four groups. The correlation between AHI and AHI was analyzed. In addition, the correlation between ApEnSITi and ODILO2T90% was analyzed. According to AHI standard, the ROC curve analysis and Joden index were used to determine the significance of ApEnSITi in the diagnosis of OSAHS and the evaluation of hypoxic degree. SPSS 16.0 software was used for statistical analysis. Results among the 500 subjects, 361 (72.2%) were males and 139 (27.8%) females. The average age was 53.2 鹵15.2 years (range 24-95 years). 1 ApEnSITi was significantly different among different groups (P0.001), and the value of ApEnSITi increased with the increase of AHI. Further comparison between the two groups showed that there was significant difference in ApEn among each group (P0.001), and there was significant difference in siti between other groups except the normal control group and the mild OSAHS group (P0.05). Spearman (?) Eye correlation analysis showed that ApEnSITi was positively correlated with AHI (r = 0.765 and R = 0.678, P 0.01). There was a good correlation between ApEnSITi and ODILO2T90%. According to the results of ROC curve analysis, Apen value of 16.70 ~ 17.81 ~ 20.03 can be used as the threshold value of mild, moderate and severe hypoxia in patients with OSAHS. The corresponding siti value is 3.6854.055V 4.445.2. According to PSG AHI 鈮，

本文編號：2065141