【摘要】：背景： 阻塞性睡眠呼吸暫停低通氣綜合征（OSAHS）是臨床常見的睡眠呼吸疾病,其病理損傷核心因素是體內(nèi)長期存在的間歇低氧/再氧合環(huán)境，OSAHS可導致機體長期低氧血癥、高碳酸血癥、大量高度活化的氧自由基（活性氧自由基ROS等）的產(chǎn)生及神經(jīng)體液調(diào)節(jié)機制的異常，其顯著的多系統(tǒng)損害被認為是一種全身性疾病。目前臨床上對重度OSAHS患者術(shù)前常規(guī)予3-7天CPAP治療，以改善低氧血癥、糾正睡眠結(jié)構(gòu)紊亂，減少圍手術(shù)期并發(fā)癥的發(fā)生。 目的： 通過對重度OSAHS住院患者術(shù)前CPAP治療前后外周血中性粒細胞內(nèi)ROS含量、血清總抗氧能力及多導睡眠監(jiān)測和ESS評分的對比研究，探討術(shù)前CPAP治療的有效性及其對心血管疾病治療的相關機制。 方法 選擇2011年10月至2012年2月在我院耳鼻咽喉-頭頸外科入院的重度OSAHS患者30例，所有病例均經(jīng)過多導睡眠圖監(jiān)測（polysomnography,PSG）確診的重度OSAHS患者（均為男性），，診斷標準為新修訂的阻塞性睡眠呼吸暫停低通氣綜合征診斷和外科治療指南(簡稱指南)。體重指數(shù)31.23±2.97kg/m2，平均年齡44.5±7.9歲。入選對象除外急（慢）性炎癥性疾病、慢性肝膽、腎臟、風濕性、骨骼、內(nèi)分泌、生殖系統(tǒng)及腫瘤等疾病，術(shù)前除CPAP治療外除外其他治療。分別于CPAP治療前后記錄睡眠呼吸暫停低通氣指數(shù)（apnea hypopneaindex,AHI）、最低血氧飽和度（lowest blood oxygen saturation，LSaO2）、平均血氧飽和度、ESS評分、以及外周血中性粒細胞ROS含量及血清總抗氧能力（T-AOC）等。中性粒細胞ROS含量檢測采用流式細胞術(shù)，TAOC通過ABTS法。 結(jié)果 OSAHS患者術(shù)前短期CPAP治療前后AHI、LSaO_2、SaO_2均值、ESS評分以及外周血中性粒細胞ROS熒光強度和血清T-AOC配對t檢驗，P值均小于0.05，差異均具有統(tǒng)計學意義。 結(jié)論 1OSAHS患者存在高水平氧化應激反應。 2術(shù)前CPAP治療可改善患者睡眠紊亂，糾正低氧血癥，改善嗜睡癥狀。 3術(shù)前CPAP治療可以降低ROS含量，提高血清總抗氧能力，改善高水平氧化應激反應。 4術(shù)前CPAP治療可輔助對OSAHS患者基礎性疾病的治療，減少圍手術(shù)期并發(fā)癥。
[Abstract]:Background: obstructive sleep apnea hypopnea syndrome (OSAHS) is a common clinical sleep respiratory disease. The core factor of its pathological injury is the chronic intermittent hypoxia / reoxygenation environment. OSAHS can lead to long-term hypoxemia, hypercapnia, the production of a large number of highly activated oxygen free radicals (ROS and so on) and abnormal neurohumoral regulation mechanism. The significant multi-system damage is considered to be a systemic disease. In order to improve hypoxemia, correct sleep structure disorder and reduce perioperative complications, the patients with severe OSAHS were treated with CPAP for 3-7 days before operation in order to improve hypoxemia, correct sleep structure disorder and reduce the incidence of perioperative complications. Objective: to compare the contents of ROS in peripheral blood neutrophils, total anti-oxygen ability of serum, polysomnography and ESS score in patients with severe OSAHS before and after CPAP treatment. To explore the efficacy of preoperative CPAP therapy and its related mechanisms for cardiovascular disease treatment. Methods from October 2011 to February 2012, 30 patients with severe OSAHS who were admitted to the department of otolaryngal-head and neck surgery in our hospital were selected. All the patients were diagnosed by polysomnography monitoring (polysomnography,PSG) (all male). The diagnostic criteria are the revised guidelines for the diagnosis and surgical treatment of obstructive sleep apnea hypopnea syndrome. Body mass index (BMI) was 31.23 鹵2.97 kg / m2 with an average age of 44.5 鹵7.9 years. The subjects were excluded from acute (chronic) inflammatory diseases, chronic hepatobiliary, renal, rheumatic, skeletal, endocrine, reproductive system and tumor diseases, with the exception of CPAP therapy before operation. Sleep apnea hypopnea index (apnea hypopneaindex,AHI), minimum oxygen saturation (lowest blood oxygen saturation,LSaO2), mean oxygen saturation, ESS score were recorded before and after treatment with CPAP. The content of ROS in peripheral blood neutrophils and total antioxidant capacity (T-AOC) in serum were also studied. The ROS content of neutrophils was detected by flow cytometry and TAOC by ABTS. Results the mean value of AHI,LSaO_2,SaO_2, ESS score, ROS fluorescence intensity of peripheral blood neutrophils and serum T-AOC pairing t test were lower than 0.05 in patients with OSAHS before and after short-term CPAP treatment (P < 0.05). The difference was statistically significant. Conclusion there is a high level of oxidative stress in patients with 1OSAHS. 2 preoperative CPAP therapy can improve sleep disorder, correct hypoxemia and improve somnolence symptoms. (3) preoperative CPAP treatment could decrease the content of ROS, improve the total antioxidant ability of serum and improve the high level of oxidative stress response. Preoperative CPAP therapy can assist in the treatment of basic diseases in patients with OSAHS and reduce perioperative complications.
【學位授予單位】：南華大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R766

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