本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + 心血管疾病　； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景和目的OSAHS是常見的睡眠呼吸疾病,可引全身多系統(tǒng)并發(fā)癥,心血管系統(tǒng)尤甚,其患病率在人群中日趨增長,嚴(yán)重危害人類身體健康。本研究通過分析南方醫(yī)院睡眠中心及心內(nèi)科OSAHS的流行病學(xué)特點(diǎn)及其與心血管病的關(guān)系,加強(qiáng)對(duì)該病的認(rèn)識(shí),并為日后的臨床篩查診治工作提供參考價(jià)值。研究對(duì)象和方法(1)收集南方醫(yī)院呼吸睡眠中心2013.01.01至2015.12.31所有完成多導(dǎo)睡眠監(jiān)測且年齡≥18周歲的住院患者完整病例資料。根據(jù)呼吸暫停低通氣指數(shù)(AHI)分為OSAHS組及非OSAHS組兩組,采用病例對(duì)照方法比較兩組的臨床特點(diǎn),多因素Logistic回歸法分析OSAHS發(fā)生的可能危險(xiǎn)因素。(2)收集南方醫(yī)院心血管內(nèi)科(包括CCU)同一時(shí)間段所有出院診斷為OSAHS的住院患者完整臨床資料,與呼吸睡眠中心OSAHS患者比較。統(tǒng)計(jì)心血管內(nèi)科確診OSAHS患者的五種心血管疾病患病率,與呼吸睡眠中心及文獻(xiàn)數(shù)據(jù)比較。統(tǒng)計(jì)心血管內(nèi)科同一時(shí)間段內(nèi)五種心血管疾病中OSAHS的患病率,五種疾病間比較。(3)根據(jù)AHI值將兩科確診OSAHS患者分別分為輕中重度三組,比較三組間各系統(tǒng)合并癥患病率。結(jié)果(1)呼吸睡眠中心三年間完善PSG的不重復(fù)住院人數(shù)1668人,確診OSAHS 775例,OSAHS患病率為46.5%;心血管內(nèi)科三年間不重復(fù)住院患者人數(shù)10389人,確診OSAHS 204例,OSAHS診斷率為1.9%,其中男性患者(2.8%)約為女性(0.7%)的4倍。(2)呼吸睡眠中心部分共納入925例患者:OSAHS組775例[男689(88.9%),女 86(11.1%)],年齡 45.9±11.8 歲;非 OSAHS 組 150 例[男 96(64.0%),女54(36.0%)],年齡47.4±13.3歲。OSAHS組患者BMI、男性比例、打鼾、日間困倦、腹型肥胖、頸短粗、咽腔狹窄比例高于非OSAHS組(P0.05);平均年齡、吸煙及飲酒史無統(tǒng)計(jì)學(xué)差異。Logistic回歸分析得出OSAHS發(fā)生的獨(dú)立危險(xiǎn)因素有:BMI、男性性別及咽腔狹窄(P0.05),而與BMI相關(guān)的腹型肥胖、頸短粗并非OSAHS獨(dú)立危險(xiǎn)因素。OSAHS組高血壓、血紅蛋白升高、高脂血癥、糖尿病及糖耐量減低患病率較非OSAHS組高,哮喘、焦慮或抑郁患病率較非OSAHS組低(P0.05);兩組患者空腹血糖受損、腦梗塞、腦出血、慢性阻塞性肺疾病、慢性腎功能不全及胃食管返流的患病率無統(tǒng)計(jì)學(xué)差異。(3)文獻(xiàn)報(bào)道OSAHS患者中高血壓、冠心病、心律失常、心力衰竭、肺動(dòng)脈高壓的患病率分別為50%,30%,50%,10%,17%;心血管內(nèi)科OSAHS患者五種疾病患病率分別為79.4%,20.9%,21.6%,12.3%,1.0%,其中高血壓患病率較文獻(xiàn)數(shù)據(jù)偏高,心律失常及肺動(dòng)脈高壓偏低,其余相差不大;呼吸睡眠中心OSAHS患者五種疾病患病率分別為40.4%,2.5%,5.8%,0.3%,0.1%,比心血管內(nèi)科及文獻(xiàn)數(shù)據(jù)均偏低。心血管內(nèi)科三年間五種疾病中OSAHS的患病率分別為2.9%,1.1%,0.7%,0.9%及0.8%,高血壓患者中OSAHS患病率最高。(4)呼吸睡眠中心OSAHS患者輕中重度三組間比較,隨著嚴(yán)重度增加,高脂血癥患病率呈遞增趨勢,焦慮或抑郁患病率遞減,其余合并癥患病率三組間無統(tǒng)計(jì)學(xué)差異;心血管內(nèi)科OSAHS患者三組間合并癥患病率均無統(tǒng)計(jì)學(xué)差異。結(jié)論(1)心血管內(nèi)科OSAHS診斷率為1.9%,較文獻(xiàn)報(bào)道的20%人群患病率明顯偏低,提示心血管內(nèi)科對(duì)于OSAHS的篩查診斷存在不足。(2)BMI、男性、咽腔狹窄作為OSAHS發(fā)生的獨(dú)立危險(xiǎn)因素,應(yīng)注意對(duì)其重點(diǎn)篩查。臨床應(yīng)以腹圍、頸圍等具體量化指標(biāo)代替主觀查體描述。OSAHS男女患病率比例為4:1,較人群研究數(shù)據(jù)(2-3:1)高,臨床應(yīng)放寬對(duì)女性的篩查標(biāo)準(zhǔn)。(3)呼吸睡眠中心對(duì)OSAHS的五種心血管合并癥篩查力度有待提高;心血管內(nèi)科應(yīng)加強(qiáng)對(duì)心律失常及肺動(dòng)脈高壓患者OSAHS的篩查。(4)OSAHS也可導(dǎo)致高脂血癥、糖代謝異常、血紅蛋白升高、轉(zhuǎn)氨酶升高等情況的發(fā)生率增高。臨床對(duì)于OSAHS患者是否合并糖代謝異常的判斷應(yīng)以糖耐量試驗(yàn)為標(biāo)準(zhǔn),糖化血紅蛋白僅作參考。(5)臨床評(píng)估OSAHS嚴(yán)重程度及合并癥發(fā)生風(fēng)險(xiǎn)時(shí),除了以AHI值為參考外,應(yīng)同時(shí)關(guān)注低氧血癥程度等指標(biāo)。
[Abstract]:Background and objective OSAHS is a common sleep respiratory disease, which can lead to systemic multiple system complications, especially in the cardiovascular system. The prevalence rate is increasing in the population and seriously endangers the human health. This study analyzed the characteristics of the flow disease and the relationship with cardiovascular disease in the sleep center of the southern hospital and the Department of Cardiology in the Department of Cardiology, and strengthened the relationship with cardiovascular disease. Understanding of the disease and providing reference value for the future clinical screening and diagnosis and treatment. Research objects and methods (1) all cases of complete cases of hospitalized patients who have completed polysomnography from 2013.01.01 to 2015.12.31 and aged over 18 years of age in the respiratory and sleep center of the southern hospital are collected and divided into group OSAHS according to the apnea hypopnea index (AHI). Non OSAHS group two groups, using case control method to compare the clinical characteristics of the two groups, multiple factor Logistic regression analysis of the possible risk factors for the occurrence of OSAHS. (2) collect the complete clinical data of all hospitalized patients with OSAHS in the same time period of the cardiovascular department of the southern hospital (including CCU), and compare with the OSAHS patients in the respiratory sleep center. The prevalence rate of five cardiovascular diseases in OSAHS patients with cardiovascular medicine was compared with the respiratory sleep center and the literature data. The prevalence of OSAHS in the five cardiovascular diseases in the same period of cardiovascular medicine and the comparison between five diseases were compared. (3) the two families of OSAHS patients were divided into three groups of moderate and severe cases according to the value of AHI, and three groups were compared. Results (1) the number of non repeated hospitalization of PSG in the three years of the respiratory sleep center was 1668, 775 cases were confirmed, the prevalence rate of OSAHS was 46.5%, 10389 in the three years of cardiovascular medicine, 204 cases of confirmed OSAHS, and 1.9% in OSAHS diagnosis, of which the male patients (2.8%) were about 4 (0.7%) 4 (2.8%). (2) 925 patients were included in the respiratory and sleep center part: 775 cases in group OSAHS [male 689 (88.9%), 86 (11.1%)], age 45.9 + 11.8, 150 cases (96 (64%) and 54 (36%)) in non OSAHS group, male proportion, snoring, daytime sleepiness, abdominal obesity, short neck, and stricture of the throat were higher than those in non OSAHS group. P0.05); average age, no statistical difference in smoking and drinking history,.Logistic regression analysis showed that the independent risk factors for OSAHS were BMI, male sex and stenosis of the pharynx (P0.05), and BMI related abdominal obesity, and neck short thickness was not the OSAHS independent risk factor.OSAHS group hypertension, hemoglobin elevation, hyperlipidemia, diabetes and glucose tolerance The incidence of reduced morbidity was higher than that in the non OSAHS group, and the prevalence of asthma, anxiety or depression was lower than that in the non OSAHS group (P0.05); there was no statistical difference between the two groups of patients with impaired fasting blood glucose, cerebral infarction, cerebral hemorrhage, chronic obstructive pulmonary disease, chronic renal insufficiency and gastroesophageal reflux. (3) the literature reports of hypertension, coronary heart disease, and arrhythmia in OSAHS patients. The prevalence of heart failure and pulmonary hypertension was 50%, 30%, 50%, 10%, 17%. The prevalence rates of five diseases in OSAHS patients were 79.4%, 20.9%, 21.6%, 12.3%, 1%, respectively, among which the prevalence of hypertension was higher than that in the literature, arrhythmia and pulmonary hypertension were low, and the rest of the disease was not significant; five diseases in the respiratory and sleep center OSAHS patients. The prevalence rate was 40.4%, 2.5%, 5.8%, 0.3%, 0.1%, compared with cardiovascular medicine and literature. The prevalence rate of OSAHS was 2.9%, 1.1%, 0.7%, 0.9% and 0.8% in five kinds of diseases in the cardiovascular medicine department for three years. (4) the patients with OSAHS in the respiratory and sleep center were compared with the moderate and severe groups, with the increase of severity. The prevalence rate of hyperlipidemia was increasing, the incidence of anxiety or depression decreased, and there was no statistical difference between the three groups of the other complications. There was no statistical difference between the three groups of OSAHS patients in cardiovascular medicine. Conclusion (1) the diagnostic rate of OSAHS in the cardiovascular medicine department was 1.9%, which was significantly lower than that of the reported 20% people. There are shortcomings in the screening and diagnosis of OSAHS in the cardiovascular medicine department. (2) BMI, male, as an independent risk factor for the occurrence of OSAHS, the stenosis of the pharynx should be considered as an independent risk factor for the occurrence of OSAHS. The specific quantitative indicators of abdominal circumference and neck circumference should be used instead of subjective examination to describe the prevalence rate of.OSAHS between men and women as 4:1, higher than the population study data (2-3:1) and clinical relaxation. Screening criteria for women. (3) screening of five types of cardiovascular complications in OSAHS should be enhanced by the respiratory sleep center; the cardiovascular department should strengthen the screening of OSAHS in patients with arrhythmia and pulmonary hypertension. (4) OSAHS may also lead to hyperlipidemia, abnormal glucose metabolism, elevated serum erythrocyte, and an increase in the incidence of aminotransferase and high levels of transaminase. The judgment of OSAHS patients with abnormal glucose metabolism should be based on glucose tolerance test and glycosylated hemoglobin as a reference. (5) when evaluating the severity of OSAHS and the risk of complication, the standard of hypoxemia should be paid attention to at the same time except for the reference of AHI.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R766

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相關(guān)期刊論文 前2條

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本文編號(hào)：1909240