本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + 肺動(dòng)脈高壓　； 參考：《天津醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的 1.探討阻塞性睡眠呼吸暫停低通氣綜合征患者肺動(dòng)脈高壓和肺心病的發(fā)生率,并對(duì)其相關(guān)危險(xiǎn)因素進(jìn)行研究,預(yù)測(cè)其對(duì)肺動(dòng)脈高壓發(fā)生、發(fā)展的影響。 2.OSAHS合并肺動(dòng)脈高壓、肺心病的患者經(jīng)CPAP治療1個(gè)月、3個(gè)月后肺動(dòng)脈收縮壓、右室前壁厚度的變化,探討其治療效果。 方法 1.經(jīng)多導(dǎo)睡眠監(jiān)測(cè)確診為OSAHS的患者行彩色多普勒超聲心動(dòng)圖檢查,根據(jù)彩色多普勒超聲心動(dòng)圖PASP將OSAHS患者分對(duì)照組和肺動(dòng)脈高壓組(PAH)。比較兩組患者呼吸紊亂指標(biāo)有無(wú)差別。 2.將CPAP治療的肺動(dòng)脈高壓組患者分為3組：①輕度肺動(dòng)脈高壓組；②中重度肺動(dòng)脈高壓組；③肺心病組：肺動(dòng)脈高壓同時(shí)有右心結(jié)構(gòu)改變患者。觀察治療前后肺動(dòng)脈收縮壓和右室前壁厚度的變化。 結(jié)果 1.389例單純睡眠呼吸暫停患者中,91例合并有肺動(dòng)脈高壓,38例合并有肺心病,肺動(dòng)脈高壓和肺心病的發(fā)病率分別為23%、9.8%。 2.PAH患者TST-SpO280%明顯高于對(duì)照組,平均SpO2、最低SpO2明顯低于對(duì)照組,差別有統(tǒng)計(jì)學(xué)意義(P0.05)；兩組患者TST-SpO290%相比差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 3.PAH組患者TST-A、AHI、最大氧減明顯高壓對(duì)照組,差別有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者TST-HY相比,差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05), 4.多因素二分類Logistic回歸分析,提示TST-A、AHI、平均SpO2可作為OSAHS并發(fā)肺動(dòng)脈高壓的危險(xiǎn)因素(P0.05)。 5.伴有肺動(dòng)脈高壓的OSAHS患者CPAP治療1個(gè)月和治療前相比,PASP無(wú)明顯降低,差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),AHI及平均SpO2有所改善,差別有統(tǒng)計(jì)學(xué)意義(P0.05)。治療3個(gè)月后與治療前相比,PASP明顯降低,差別有統(tǒng)計(jì)學(xué)意義(P0.05),AHI及平均SpO2明顯改善,差別有統(tǒng)計(jì)學(xué)意義(P0.05)。 6.伴有肺心病的OSAHS患者CPAP治療1個(gè)月和治療前相比,PASP無(wú)明顯降低,差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。右室前壁厚度無(wú)明顯減少,差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。CPAP治療3個(gè)月與治療前相比,PASP明顯降低,差別有統(tǒng)計(jì)學(xué)意義(P0.05),右室前壁厚度明顯減少,差別有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 1.OSAHS是肺動(dòng)脈高壓肺心病的獨(dú)立危險(xiǎn)因素,23%的OSAHS并發(fā)肺動(dòng)脈高壓,9.8%的OSAHS并發(fā)肺心病。 2.TST-A、AHI、平均Sp02是OSAHS并發(fā)肺動(dòng)脈高壓的獨(dú)立危險(xiǎn)因素。 3.對(duì)于合并肺動(dòng)脈高壓和(或)肺心病的OSAHS患者,CPAP是降低其肺動(dòng)脈壓力、改善右心結(jié)構(gòu)的有效手段,經(jīng)過(guò)CPAP長(zhǎng)期治療,肺血管重構(gòu)及右心結(jié)構(gòu)肥厚能夠發(fā)生逆轉(zhuǎn)。
[Abstract]:Purpose 1. To investigate the incidence of pulmonary hypertension and cor pulmonale in patients with obstructive sleep apnea hypopnea syndrome (OSAS). Patients with 2.OSAHS complicated with pulmonary hypertension and cor pulmonale were treated with CPAP for 1 month. After 3 months, the changes of pulmonary artery systolic pressure and the thickness of the anterior wall of right ventricle were studied. Method 1. The patients with OSAHS diagnosed by polysomnography were examined by color Doppler echocardiography. According to the color Doppler echocardiography (PASP), the patients with OSAHS were divided into control group and pulmonary hypertension group. To compare the difference of respiratory disorders between the two groups. 2. The patients with pulmonary hypertension treated with CPAP were divided into 3 groups: 1 / 1 mild pulmonary hypertension group, 2 moderate and severe pulmonary hypertension group and 3 cor pulmonale group: pulmonary hypertension patients with right heart structure change. Pulmonary artery systolic pressure and right ventricular anterior wall thickness were observed before and after treatment. Result Of the 1.389 patients with simple sleep apnea, there were 91 cases with pulmonary hypertension and 38 cases with pulmonary heart disease. The incidence of pulmonary hypertension and cor pulmonale were 239.8%. TST-SpO 280% in 2.PAH patients was significantly higher than that in the control group (P 0.05), the average SPO 2 and the lowest SpO2 were significantly lower than those in the control group (P 0.05), but there was no significant difference between the two groups in TST-SpO 290%. In the 3.PAH group, the maximal oxygen reduction was significantly higher than that in the control group (P 0.05). There was no significant difference in TST-HY between the two groups (P 0.05). 4. The multivariate two-classification Logistic regression analysis suggested that the average SpO2 could be used as a risk factor for OSAHS complicated with pulmonary hypertension (P0.05). 5. There was no significant decrease of CPAP in OSAHS patients with pulmonary hypertension after 1 month compared with that before treatment. The difference was not statistically significant (P 0.05) and the average SpO2 was improved (P 0.05). After 3 months of treatment, PASP was significantly lower than that before treatment, the difference was statistically significant (P 0.05) and the average SpO2 was significantly improved (P 0.05). 6. The CPAP of OSAHS patients with cor pulmonale was not significantly lower than that before treatment for 1 month, and the difference was not statistically significant (P 0.05). There was no significant difference in the thickness of anterior wall of right ventricle. The difference was not statistically significant. The PASP was significantly lower than that before treatment for 3 months. The difference was statistically significant (P 0.05) and the thickness of anterior wall of right ventricle was significantly decreased (P 0.05). Conclusion 1.OSAHS is an independent risk factor for pulmonary hypertension pulmonary heart disease. 23% of OSAHS complicated with pulmonary hypertension and 9.8% of OSAHS complicated with cor pulmonale. 2. Average Sp02 was an independent risk factor for OSAHS complicated with pulmonary hypertension. 3. OSAHS in patients with pulmonary hypertension and / or cor pulmonale is an effective method to reduce pulmonary artery pressure and improve the structure of right heart. After long-term treatment of CPAP, pulmonary vascular remodeling and hypertrophy of right heart structure can be reversed.
【學(xué)位授予單位】：天津醫(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)】：R766

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