本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + 高血壓��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景與目的阻塞性睡眠呼吸暫停低通氣綜合征(Obstructive Sleep Apnea-Hypopnea syndrome,OSAHS)是睡眠呼吸障礙有關(guān)的國際公共衛(wèi)生問題之一,是多種因素導(dǎo)致的上氣道反復(fù)堵塞引起節(jié)律性呼吸暫停和低通氣,與OSAHS相關(guān)聯(lián)的高血壓稱為阻塞性睡眠呼吸暫停相關(guān)性高血壓。隨著社會的發(fā)展和醫(yī)學(xué)技術(shù)的進步,人們對生活質(zhì)量的要求進一步提高,OSAHS的診斷和治療受到重視。在我國OSAHS越來越普遍,發(fā)病率不斷升高,成年人中OSAHS發(fā)病率在2%~4%,可引發(fā)全身多種多系統(tǒng)疾病,因低氧血癥引發(fā)腦缺氧,患者往往具有白天嗜睡、乏力、精神差、注意力難集中等癥狀,加之其他心、腦、腎、內(nèi)分泌疾病,患者生活質(zhì)量和生命安全受到嚴重威脅,工作效率下降,高空、駕駛多發(fā)事故,安全生產(chǎn)受到影響。高血壓在世界范圍內(nèi)都是一種比較常見的疾病,相關(guān)數(shù)據(jù)統(tǒng)計,世界各國發(fā)病率均高達10%~20%,高血壓對人們健康的威脅非常大,帶給患者的心理壓力影響了他們的生活質(zhì)量。而當今社會越來越多的人過著不健康的生活方式,加上巨大的就業(yè)壓力,導(dǎo)致高血壓人群的數(shù)量居高不下,高血壓一旦病發(fā)十分兇險,甚至?xí)鹦哪X腎血管疾病等,對高血壓相關(guān)疾病的預(yù)防和治療,深受廣大民眾的關(guān)注。有學(xué)者指出,OSAHS是繼發(fā)性高血壓病因之首,兩種病癥之間存在著很大的聯(lián)系。越來越多的醫(yī)學(xué)界專家投入到相關(guān)研究中,目前的研究成果來看,持續(xù)氣道正壓通氣是常見的治療方式,也經(jīng)常在臨床治療中使用,治療效果好。雖然如此,有關(guān)OSAHS相關(guān)性高血壓的影響因素研究成果卻并不多,缺乏權(quán)威性的研究結(jié)論,還需要進一步加強和深入研究。本研究對OSAHS相關(guān)性高血壓的多種影響因素進行觀察分析,探討OSAHS是否為高血壓的獨立危險因素,明確相關(guān)影響因素,為OSAHS相關(guān)性高血壓的早期診斷和防治提供參考依據(jù)。對象與方法回顧性分析鄭州大學(xué)人民醫(yī)院(河南省人民醫(yī)院)2015年3月-2016年12月期間前來就診的150例OSAHS患者,均經(jīng)多導(dǎo)睡眠監(jiān)測確診,制作問卷調(diào)查表,記錄患者姓名、性別、年齡、職業(yè)、體質(zhì)指數(shù)(BMI)、頸圍、腰圍、吸煙史、飲酒史、日間嗜睡狀況、相關(guān)體征及SBP、DBP情況等一般信息資料,及多導(dǎo)睡眠監(jiān)測、血氧飽和度等檢查結(jié)果,根據(jù)2012年《阻塞性睡眠呼吸暫停相關(guān)性高血壓臨床診斷和治療專家共識》,患者最終被分為兩組:OSAHS相關(guān)性高血壓組和非高血壓組,并對OSAHS相關(guān)性高血壓的多種影響因素進行回歸分析,得出結(jié)論。采用SPSS 15.0軟件進行統(tǒng)計學(xué)處理,計量資料以均數(shù)±標準差(±s)表示,兩組間比較采用重復(fù)測量數(shù)據(jù)方差分析及t檢驗,定性資料以率(%)表示,兩組間比較采用卡方檢驗,以高血壓為結(jié)局變量進行多自變量Logistic回歸分析,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果經(jīng)過對以上研究整理,可以看到,兩組患者吸煙、白天嗜睡、家族性高血壓病史、下頜后縮、腭垂過長(過寬)、體重、BMI、頸圍、腰圍差異有統(tǒng)計學(xué)意義;兩組患者睡眠監(jiān)測結(jié)果中AHI(χ2=2.342,P=0.032)、LSaO2(χ2=-2.627,P=0.012)、MSaO2(χ2=-2.108,P=0.043)、CT90%(χ2=2.426,P=0.031)、ODI(χ2=2.107,P=0.039)、微覺醒指數(shù)(χ2=2.074,P=0.023)、總呼吸暫停時間(χ2=2.272,P=0.025)、最長呼吸暫停時間(χ2=2.437,P=0.024)的差異具有統(tǒng)計學(xué)意義,結(jié)果顯示,低氧和呼吸暫停的程度與高血壓發(fā)病有關(guān)。以患者高血壓為因變量,以吸煙史、白天嗜睡、家族性高血壓病史、下頜后縮、腭垂過長(過寬)、體重、BMI、頸圍、腰圍、AHI、LSaO2、MSaO2、CT90%、ODI、微覺醒指數(shù)、總呼吸暫停時間、最長呼吸暫停時間為自變量進行多因素logistic回歸分析,結(jié)果P值分別為0.016、0.009、0.011、0.037,OR值分別為3.216、1.147、5.618、1.075,提示吸煙史、BMI、白天嗜睡和最長呼吸暫停時間是OSAHS相關(guān)性高血壓的獨立危險因素。結(jié)論通過本研究進一步證實,OSAHS相關(guān)性高血壓具有較高的發(fā)病率,與性別、煙酒史、下頜、舌體、腭垂的結(jié)構(gòu)、肥胖與否及程度、缺氧程度、覺醒次數(shù)有密切關(guān)系,男性、長期過度吸煙飲酒、上呼吸道塌陷阻塞、肥胖、缺氧等是OSAHS相關(guān)性高血壓的發(fā)病因素,其中吸煙、BMI、嗜睡、最長呼吸暫停時間是OSAHS相關(guān)性高血壓的獨立危險因素。
[Abstract]:Background and objective: obstructive sleep apnea hypopnea syndrome (Obstructive Sleep Apnea-Hypopnea syndrome, OSAHS) is one of the international public health issues related to sleep apnea, the upper airway is caused by many factors caused by blockage of rhythmic repeated apnea and hypopnea associated hypertension and OSAHS, known as the relationship between obstructive sleep apnea hypertension. With the development of society and the progress of medical technology, people need to further improve the quality of life, pay attention to the diagnosis and treatment of OSAHS. OSAHS is more and more common in our country, the incidence is rising, the adults in the incidence of OSAHS in 2%~4%, can cause systemic multi system disease, hypoxemia caused by cerebral hypoxia patients often have, daytime sleepiness, fatigue, poor spirit, difficulty concentrating and other symptoms such as heart, brain, kidney, endocrine disease, patients with life The quality of life and a serious threat to the safety, decreased work efficiency, high altitude, driving accident, safety production is affected. Hypertension is a common disease in the world, the relevant statistical data, the world incidence rate is as high as 10%~20%, hypertension is very large for people's health threat to the patient's psychological pressure affects their quality of life. But nowadays more and more people live a healthy lifestyle, coupled with the huge employment pressure, resulting in the number of hypertension is high in hypertension, once the disease is very dangerous, even can cause cardiovascular and renal vascular disease, prevention and treatment of hypertension related diseases, the majority of the public's attention. Some scholars have pointed out that OSAHS is the first cause of secondary hypertension, there is a great relationship between the two diseases. More and more medical experts into phase In the research, the results of the current study, CPAP is the common treatment methods are often used in clinical treatment, the treatment effect is good. However, research results about the effect of OSAHS related factors of hypertension are not many, the lack of authoritative research results, also need to further strengthen and further study the study on the influence of multi factors. OSAHS related hypertension were observed and analyzed to investigate whether OSAHS is an independent risk factor of hypertension, clear related factors, and provide reference for early diagnosis and treatment of OSAHS induced hypertension. The object and method of analysis of Zhengzhou University people's Hospital (Henan Province People's Hospital) reviewed 150 cases of OSAHS patients during the March 2015 -2016 year in December come to see the doctor, were diagnosed by polysomnography monitoring, making questionnaire, record the patient's name, gender, age, occupation, body Quality index (BMI), neck circumference, waist circumference, smoking history, drinking history, daytime sleepiness, signs and related SBP, DBP and other general information, and polysomnography, oxygen saturation and other examination results, according to the 2012 "obstructive sleep apnea related hypertension diagnosis and treatment expert consensus" patients the final was divided into two groups: OSAHS correlation between hypertension group and non hypertension group, and a variety of effects on OSAHS related factors of hypertension by regression analysis. The conclusion was analyzed by SPSS 15 software, the measurement data to mean + standard deviation (+ s) said that the two groups were compared using ANOVA and t test the repeated measurement data, using qualitative data rate (%), two groups were compared by chi square test, multiple regression analysis with hypertension as the independent variable Logistic outcome variables, P0.05 difference was statistically significant. Results after the 涓婄爺絀舵暣鐞，

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