本文選題：超聲心動圖　切入點：左室重構(gòu)　出處：《山西醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討阻塞性睡眠呼吸暫停綜合征(Obstructive Sleep Apnea Syndrome, OSAS)患者的左室重構(gòu)(Left Ventricular Remodeling, LVR)類型及心血管危險因素對其構(gòu)型的影響。 方法：因打鼾疑為OSAS入我院進(jìn)行多導(dǎo)睡眠監(jiān)測(Polysomnography, PSG)的患者共198例,并行24小時動態(tài)血壓監(jiān)測,記錄夜間血壓(nSBP, nDBP24:00、2：00、4：00)、晨起血壓(mSBP, mDBP6:00、8:00)和白天血壓(dSBP, dDBP22:00、12：00),一般資料(性別、年齡、身高、體重、頸圍、腰圍、臀圍、吸煙史、飲酒史、高血壓、糖尿病、臨床癥狀及體征、家族史及工作性質(zhì)等),于次日晨檢測甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)、血紅蛋白(Hb)、血肌酐(SCr)、尿素氮(BUN)、空腹血糖(Fasting Glucose)。其中排除多導(dǎo)睡眠監(jiān)測AHI5次/h者23例,原始數(shù)據(jù)資料不完整者11例,腦梗塞患者11例,先天胸廓畸形患者1例,手術(shù)治療后復(fù)查無治療前數(shù)據(jù)者4例,最終AHI≥5次/h的148例OSAS患者入選。次日晨進(jìn)行超聲心動圖檢查,測量舒張末期和收縮末期左室內(nèi)徑(LVDd和LVSd)、舒張末期室間隔和左室后壁厚度(IVST和LVPWT),計算相對室壁厚度(RWT)和左室質(zhì)量指數(shù)(LVMI).根據(jù)RWT≥0.42和LVMI≥46.7g/m2.7(女)或49.2g/m27(男),將左室?guī)缀螛?gòu)型分為正常構(gòu)型(Normal Geometry, NG),向心性重構(gòu)(Concentric Remodeling, CR),離心性肥厚(Eccentric Hypertrophy, EH)和向心性肥厚(Concentric Hypertrophy,CH),并應(yīng)用多變量logistic回歸分析(Multinomial logistic regression)統(tǒng)計方法研究心血管危險因素與左室重構(gòu)類型的相關(guān)性。 結(jié)果：1.148例OSAS患者,其中115例(77.7%)患者發(fā)生左室?guī)缀螛?gòu)型的改變,四種構(gòu)型的比率分別為NG33例(22.3%),CR35例(23.6%),EH37例(25%)及CH43例(29.1%),其中向心性幾何構(gòu)型(52.7%)(包括CR與CH)所占比例高于EH(25%)。2.一般資料的特征：①與NG組比較,EH組BMI及腰圍均升高,差異均有統(tǒng)計學(xué)意義(P0.01)；CH組年齡、BMI、腰圍、高血壓、dSBP mn及nSBP mn均升高,差異均有統(tǒng)計學(xué)意義(P0.05或P0.01)。②與CR組比較,EH組年齡、BMI及腰圍均升高,差異均有統(tǒng)計學(xué)意義(P0.05或P＜0.01）；CH組性別、年齡、BMI、腰圍、高血壓、_nSBPmn及TG均升高，差異均有統(tǒng)計學(xué)意義（P＜0.05或P＜0.01）。③與EH組比較，CH組高血壓發(fā)病率升高，差異有統(tǒng)計學(xué)意義（P＜0.05）。3.呼吸指標(biāo)的特征：①與NG組比較，CR組AHI及ODI均升高，，差異均有統(tǒng)計學(xué)意義（P＜0.05或P＜0.01）；CH組AHI、ODI及T90均升高，而MeanSO_2及LowestSO_2均降低，差異均有統(tǒng)計學(xué)意義（P＜0.05或P＜0.01）。②與CR組比較，EH組AHI降低，差異有統(tǒng)計學(xué)意義（P＜0.05）；CH組MeanSO_2降低，而T90升高，差異均有統(tǒng)計學(xué)意義（P＜0.05或P＜0.01）。③與EH組比較，CH組LowestSO_2降低，差異有統(tǒng)計學(xué)意義（P＜0.05）。4.各點血壓測量值的特征：①與NG組比較，CH組4:00SBP及6:00SBP均升高，差異均有統(tǒng)計學(xué)意義（P＜0.05）。②與CR組比較，CH組22:00SBP升高，差異有統(tǒng)計學(xué)意義（P＜0.05）。5.采用多變量Logistic回歸分析統(tǒng)計方法，校正混雜因素的作用后（年齡、BMI、_dSBPmn、_nSBPmn、4:00SBP、6:00SBP、AHI、LowestSO_2、Mean SO_2、T90及ODI），CR與AHI相關(guān)（OR1.035，P=0.024），EH與年齡、BMI及4:00SBP相關(guān)（OR1.094，P=0.016）、（OR1.397，P=0.011）、（OR1.124，P=0.026），CH與年齡相關(guān)（OR1.084，P=0.028）。 結(jié)論：1.OSAS可引起LVR，且四種構(gòu)型所占比率相類似。2.年齡、AHI分別為CH、CR的重要決定因素，年齡、BMI、4:00SBP是EH的重要決定因素。
[Abstract]:Objective: To investigate the effects of Left Ventricular Remodeling (LVR) and cardiovascular risk factors on the configuration of patients with Obstructive Sleep Apnea Syndrome (OSAS).
Methods: by snoring suspected OSAS in our hospital were monitored by polysomnography (Polysomnography, PSG) with a total of 198 cases, parallel 24 hour ambulatory blood pressure monitoring and recording of nocturnal blood pressure (nSBP, nDBP24:00,2:00,4:00), morning blood pressure (mSBP, mDBP6:00,8:00) and daytime blood pressure (dSBP, dDBP22:00,12:00), general data (sex, age, height, weight, neck circumference, waist circumference, hip circumference, smoking history, drinking history, hypertension, diabetes, clinical symptoms and signs, family history and the nature of the work, etc.) in the morning (TG), detection of triglyceride total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein the cholesterol (LDL-C), hemoglobin (Hb), serum creatinine (SCr), urea nitrogen (BUN), fasting blood glucose (Fasting Glucose). 23 cases were excluded polysomnography AHI5 times of /h, 11 cases of the original data is not complete, 11 cases of patients with cerebral infarction, 1 patients with congenital malformation of the chest hand. 4 patients after treatment was no data before treatment, 148 patients with OSAS were more than 5 times the final AHI /h. The following morning echocardiography measured left ventricular end diastolic and end systolic diameter (LVDd and LVSd), interventricular septum and left ventricular posterior wall thickness (IVST and LVPWT). The calculation of relative wall thickness (RWT) and left ventricular mass index (LVMI). According to RWT = 0.42 and LVMI = 46.7g/m2.7 (female) or 49.2g/m27 (male), the left ventricular geometry divided into normal geometry (Normal Geometry, NG), concentric remodeling (Concentric Remodeling, CR) and eccentric hypertrophy (Eccentric Hypertrophy, EH) and concentric hypertrophy (Concentric Hypertrophy, CH), and the application of multivariate logistic regression analysis (Multinomial logistic regression) the correlation between risk factors and cardiovascular research statistical methods left ventricular remodeling type.
緇撴灉錛

本文編號：1633484