本文選題：阻塞性睡眠呼吸暫停低通氣綜合征obstructive　切入點：sleep　出處：《華中科技大學》2012年博士論文　論文類型：學位論文

【摘要】：第一部分 阻塞性睡眠呼吸暫停低通氣綜合征疾病嚴重程度與代謝綜合征 目的：探討不同程度阻塞性睡眠呼吸暫停低通氣綜合癥(obstructive sleep apnea hypopnea syndrome, OSAHS)患者代謝綜合征的發(fā)病率、影響因素及臨床特點。 方法：采用回顧性分析,97例經整夜多導睡眠監(jiān)測確診為OSAHS患者,依AHI指數(shù)分為輕中度(5-≤AHI30)、重度(30AHI55)及極重度(AHI55)3組,詢問、記錄高血壓、冠心病、糖尿病或糖代謝異常、高血脂或脂代謝異常病史及用藥史,測量記錄收縮壓、舒張壓、身高、體重、頸圍、腰圍等一般身體情況。整夜睡眠監(jiān)測次日晨起時標準靜脈穿刺抽取前臂肘靜脈空腹血,全自動生化分析儀檢測空腹血糖、血總膽固醇、甘油三脂、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇等生化指標。依“2007年中國成人血脂異常防治指南”對代謝綜合征進行診斷。分析比較不同程度OSAHS患者代謝綜合征的發(fā)病率、在不同組別的分布特點、臨床特征等。計量數(shù)據用均數(shù)±標準差(mean±sd)表示,使用spss17.0統(tǒng)計軟件進行數(shù)據統(tǒng)計與分析,采用非參數(shù)獨立樣本t檢驗比較組內、組間差異性,P0.05,認為差異具有統(tǒng)計學意義,P0.01,認為差異具有高度統(tǒng)計學意義。Pearson相關性檢驗兩組數(shù)據之間的相關性。采用多因素logistic回歸分析以除外混雜因素對結果的影響。 結果：本研究OSAHS組中代謝綜合征的發(fā)病率為48.5%,各組別的發(fā)病率分別為：輕中度組為33.3%,重度組為43.3%,極重度組57.1%。顯示隨AHI指數(shù)的增加,代謝綜合征的發(fā)病率也逐步增高,二者之間顯著相關(t=-2.39,P=0.019)。與未合并代謝綜合征的OSAHS患者相比,合并代謝綜合征的OSAHS患者的腹圍(t=-3.32,P=0.001)、體塊指數(shù)(t=-3.23,P=0.002)、最低血氧飽和度(t=2.47,P=0.015)、3%氧減指數(shù)(t=-2.18,P=0.032)等均存在有統(tǒng)計學意義或顯著統(tǒng)計學意義的差異。在代謝相關指標如空腹血糖、甘油三酯、高密度脂蛋白等二者之間也存在有統(tǒng)計學意義的差異。結論：代謝綜合征是OSAHS患者的并發(fā)癥之一,并隨OSAHS程度加重其患病率逐步增加。腹型肥胖、夜間反復低氧血癥可能是OSAHS患者并發(fā)代謝綜合征的危險因素之一。 第二部分 OSAHS患者疾病嚴重程度臨床評估的初步探討 目的: OSAHS是多器官多系統(tǒng)的綜合征,單一AHI指數(shù)不能全面反映其疾病嚴重程度,單純依靠AHI指數(shù)判斷疾病嚴重程度,可能會導致臨床治療的過度或不足。本研究目的是建立以并發(fā)或伴發(fā)疾病嚴重程度配合OSAHS基礎生理指標的評估模型,以期更好的指導臨床。 方法：按制定的入選與排除標準,經整夜多導睡眠監(jiān)測診斷為OSAHS患者,共97例資料完整病例進入本研究。對所有病例按制定的臨床評估模型進行評估,比較其結果與AHI指數(shù)及臨床癥狀的差異性。計量數(shù)據用均數(shù)±標準差(mean±sd)表示,使用spss17.0統(tǒng)計軟件進行數(shù)據統(tǒng)計與分析,采用非參數(shù)獨立樣本t檢驗比較組間差異性,P0.05,認為差異具有統(tǒng)計學意義,P0.01,認為差異具有高度統(tǒng)計學意義。 結果：按AHI指數(shù)分組,7例輕度OSAHS患者經臨床評分后,有2例被評為臨床中度,3例被評為重度。加分項目主要有：2例為血壓升高,2例為脂代謝異常,4例為白天嗜睡明顯。12例中度OSAHS患者經臨床評分后,2例被評為輕度,9例被評為重度,加分項目主要有：7例為脂代謝異常,2例為血壓升高,1例為糖代謝紊亂。78例重度OSAHS患者中經臨床評分后,6例被評為輕度,3例被評為中度,其余被評為重度,但得分均有上升。6例被評為輕度患者均無明顯并發(fā)或伴發(fā)疾病,3例被評為中度者伴發(fā)疾病為舒張壓升高。在評為重度患者中普遍加分超過3以上,主要以脂代謝異常及白天嗜睡明顯。少部分為血壓或空腹血糖異常。經統(tǒng)計學處理,AHI分組評估與臨床模型評估結果相比較,差異明顯。 結論：以OSAHS伴發(fā)或并發(fā)疾病配合基礎生理指標評分來評價0SAHS疾病嚴重程度明顯好于單一使用AHI指數(shù),更有利于指導臨床干預。
[Abstract]:The first part
Obstructive sleep apnea hypopnea syndrome and the severity of the disease and metabolic syndrome
Objective: To evaluate the severity of obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea hypopnea syndrome, OSAHS) in patients with metabolic syndrome incidence, clinical features and influencing factors.
Methods: a retrospective analysis of 97 cases diagnosed by whole night polysomnography for OSAHS patients, according to the AHI index divided into mild to moderate (5- = AHI30), severe and very severe (30AHI55) (AHI55) 3 groups, inquiry, history of hypertension, coronary heart disease, diabetes or impaired glucose metabolism, high blood lipids or lipid metabolism abnormal history and medication history, measurement of systolic blood pressure, diastolic blood pressure, height, weight, neck circumference, waist circumference and general health. The next morning when the night sleep monitoring standard intravenous puncture of forearm venous blood fasting, fasting blood glucose detection and automatic biochemical analyzer, blood total cholesterol, glycerin three fat, high density lipoprotein cholesterol, low density lipoprotein cholesterol and other biochemical indicators. According to the "2007 Chinese adult dyslipidemia prevention guide" for the metabolic syndrome diagnosis. Analysis of incidence of different degree of metabolic syndrome in patients with OSAHS rate distribution in different groups. Point of clinical characteristics. The mean and standard deviation for the measurement data (mean + SD) said that the statistics and analysis of data using SPSS17.0 statistical software, using non parametric independent samples t test were used to compare the differences between groups, P0.05, that has statistical significance, the difference of P0.01, that the difference is highly significant.Pearson correlation test for correlation between the two sets of data. By using logistic regression analysis to exclude confounding factors impact on the results.
Results: the incidence of metabolic syndrome in the OSAHS group was 48.5%, the incidence rate of each group were: mild and moderate severe group 33.3%, group 43.3%, group 57.1%. showed very severe with the increase of AHI index, the incidence of metabolic syndrome is also gradually increased, a significant correlation between the two (t=-2.39. P=0.019). Compared with OSAHS patients without metabolic syndrome combined with metabolic syndrome in patients with OSAHS (t=-3.32, P=0.001), abdominal circumference body mass index (t=-3.23, P=0.002), the lowest oxygen saturation (t=2.47, P=0.015), 3% oxygen desaturation index (t= -2.18, P=0.032). There were differences were statistically significant or was significant. In triglyceride metabolism related indicators, such as fasting glucose, there had significant difference between high density lipoprotein two. Conclusion: the metabolic syndrome is one of the complications of OSAHS patients, and the patients with the aggravation of OSAHS The disease rate is increasing gradually. Abdominal obesity, repeated nocturnal hypoxemia may be one of the risk factors of OSAHS patients complicated with metabolic syndrome.
The second part
Preliminary study of clinical assessment of disease severity in patients with OSAHS
Objective: OSAHS syndrome is a multi organ and multi system, single AHI index can not reflect the severity of the disease, relying solely on the AHI index to judge the severity of the disease, clinical treatment may lead to excessive or insufficient. The purpose of this study is to establish concurrent or concomitant disease severity assessment with OSAHS based physiological index model, in order to better guide the clinical.
Methods: according to the inclusion and exclusion criteria, the all night polysomnography diagnosis for OSAHS patients in this study were 97 cases with complete data on all cases. According to the clinical evaluation model is formulated to evaluate compared results with AHI index and clinical symptoms. The measurement data with mean + standard the difference (mean + SD) said that the statistics and analysis of data using SPSS17.0 statistical software, using non parametric independent sample t test to compare the differences between groups, P0.05, that has statistical significance, the difference of P0.01, that the difference is highly significant.
緇撴灉錛氭寜AHI鎸囨暟鍒嗙粍,7渚嬭交搴SAHS鎮(zhèn)ｈ，

本文編號：1642858