本文關(guān)鍵詞：阻塞性睡眠呼吸暫停低通氣綜合征患者治療現(xiàn)狀調(diào)查　出處：《廣州醫(yī)科大學》2014年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 阻塞性睡眠呼吸暫停低通氣綜合征 治療現(xiàn)狀 電話回訪

【摘要】：目的 研究顯示美國約90%的阻塞性睡眠呼吸暫停低通氣綜合征（OSAHS）患者未經(jīng)臨床診斷，未經(jīng)治療OSAHS患者的并發(fā)癥、病死率顯著增高。中國OSAHS患者的診斷率可能更低，對確診患者的接受治療情況還缺乏了解，我們擬調(diào)查我院經(jīng)多導睡眠監(jiān)測（PSG）確診為OSAHS患者的治療現(xiàn)狀。 方法 電話回訪2001年1月至2011年6月期間在廣州醫(yī)科大學附屬第一醫(yī)院睡眠中心經(jīng)PSG確診的3080例OSAHS及單純鼾癥患者接受治療的情況，對收集的回訪結(jié)果及存留的PSG報告有關(guān)資料匯總后進行相關(guān)指標的比較和統(tǒng)計學分析。 結(jié)果 1、電話回訪成功1270人，其中OSAHS患者1126人，，單純鼾癥患者144人，平均回訪成功率41.23%，失訪原因主要是聯(lián)系方式改變，占比達82.65%； 2、627例（55.68%）OSAHS患者接受了治療，接受單純CPAP治療281人（24.95%），單純手術(shù)125人（11.10%），單純減重84人（7.46%），綜合治療78人（6.93%），其他59人（5.24%）； 3、未治療OSAHS患者499人（44.32%），未治療原因為：自覺病情不重不需要治療253人（50.70%），害怕手術(shù)及呼吸機、口腔矯治器治療麻煩84人（16.84%），工作忙沒時間75人（15.03%），擔心療效不好58人（11.62%），治療費用昂貴29人（5.81%）； 4、單純CPAP治療患者睡眠質(zhì)量總改善率及顯著改善率分別為87.54%、48.75%，單純手術(shù)為77.60%、34.40%，單純減重為77.38%、19.05%，綜合治療為89.74%、50.00%；單純CPAP和綜合治療患者睡眠質(zhì)量總改善率及顯著改善率比較無統(tǒng)計學差異（P0.05），均高于其余兩種治療方式（P0.05）；單純手術(shù)患者與單純減重患者比較睡眠質(zhì)量總改善率無統(tǒng)計學差異（P0.05），顯著改善率高于減重患者（P0.05），但有29例（29.90%）術(shù)后睡眠質(zhì)量改善患者一段時間后出現(xiàn)復發(fā)； 5、采用單純CPAP治療患者281人，有116人（41.28%）放棄治療，放棄原因為治療麻煩不能堅持47人（40.52%），療效不佳27人（23.28%），對呼吸機不耐受19人（16.38%），自覺癥狀改善無需治療16人（13.79%），其他7人（6.03%）； 6、125例單純外科手術(shù)治療患者中，86例（68.80%）采用UPPP及改良UPPP；17例（13.60%）采用鼻腔擴容術(shù)；14例（11.20%）采用單純扁桃體切除術(shù)；8例（6.40%）患者采用其他術(shù)式； 7、單純鼾癥和輕、中、重度及總OSAHS患者高血壓患病率分別為13.19%、23.47%、29.33%、37.30%、33.21%，隨OSAHS嚴重程度增加，高血壓患病率不斷升高（χ2=40.40，P0.01）；總OSAHS患者高血壓患病率顯著高于單純鼾癥患者（P0.01）。 8、單純鼾癥和輕、中、重度及總OSAHS患者接受治療率分別為25.00%、35.68%、44.71%、64.96%、55.68%，隨OSAHS嚴重程度的增加，OSAHS患者接受治療率不斷提高（χ2=116.70，P0.01）；總OSAHS患者接受治療率顯著高于單純鼾癥患者（P0.01）。 9、單純鼾癥和輕、中、重度及總OSAHS患者有高血壓組接受治療率分別為26.35%、38.00%、55.74%、73.00%、65.51%，無高血壓組接受治療率分別為24.80%、34.97%、40.14%、60.18%、51.60%。其中單純鼾癥和輕度OSAHS患者有高血壓組與無高血壓組比較，接受治療率差異無統(tǒng)計學意義（P0.05）；中度、重度及總OSAHS患者有高血壓組接受治療率均顯著高于無高血壓組（P0.05）。 結(jié)論 1、44.32%的OSAHS患者未采取任何治療措施，對該疾病危害性缺乏認識是影響治療的主要因素，呼吸機治療麻煩、害怕手術(shù)、擔心治療效果、治療費用昂貴亦是重要影響因素。 2、在接受治療患者中，近半數(shù)選擇CPAP治療，可能與我院睡眠監(jiān)測室歸屬呼吸內(nèi)科有關(guān)，但約40%采用CPAP治療的患者放棄了CPAP治療。 3、隨OSAHS嚴重程度及高血壓患病率的增加，患者接受治療率也不斷提高。 4.本研究通過長時間、大樣本資料觀察確診OSAHS患者的治療狀態(tài)，表明在中國OSAHS患者的治療情況不容樂觀，有待在加強患者對該疾病的認識，提高治療效果等方面進行努力。
[Abstract]:objective
Research shows that about 90% of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) patients without clinical diagnosis, the treatment of OSAHS patients without complications, the mortality rate is significantly higher in patients with OSAHS. Chinese diagnostic rate may be lower, but also a lack of understanding of the patients received treatment, we intend to investigate in our hospital by polysomnography (PSG) were present in the treatment of OSAHS patients.
Method
During the period of January 2001 to June 2011 telephone interview at the Guangzhou Medical University sleep center of the First Affiliated Hospital of 3080 patients with OSAHS diagnosed by PSG and snoring patients treated, comparison and statistical analysis of return results to collect and retention PSG report relevant information after the summary of relevant indicators.
Result
1, 1270 patients were successful in telephone interviews, including 1126 OSAHS patients and 144 snoring patients. The average return visit success rate was 41.23%. The main reason for the loss of visits was the contact mode change, accounting for 82.65%.
2627 patients (55.68%) received OSAHS treatment, 281 patients received simple CPAP treatment (24.95%), 125 patients received simple surgery (11.10%), 84 patients gained weight loss (7.46%), 78 patients (6.93%) were treated by comprehensive treatment, and the other 59 patients (59).
3, 499 patients with untreated OSAHS (44.32%), no treatment due to illness is not serious: consciously do not need treatment of 253 people (50.70%), fear of surgery and ventilator, oral appliances for the treatment of trouble of 84 people (16.84%), busy no time to 75 people (15.03%), 58 people worry about bad curative effect (11.62%) the treatment is expensive, 29 people (5.81%);
4, CPAP alone, the total improvement rate and quality of sleep in patients with significant improvement rate were 87.54%, 48.75%, 77.60% and 34.40%, simple operation, simple weight loss was 77.38%, 19.05%, 89.74% and 50%; comprehensive treatment, pure CPAP and sleep quality of patients with comprehensive treatment the total improvement rate and significantly improve the rate of no significant difference (P0.05), were higher than those of the other two treatments (P0.05); simple surgery patients with simple weight loss patients sleep quality total improvement rate showed no significant difference (P0.05), significantly improve the rate of weight loss patients (P0.05), but there were 29 cases (29.90%) patients with recurrence of a period of time after surgery and improve the quality of sleep;
5, 281 patients were treated with CPAP alone. 116 patients (41.28%) gave up treatment. The reason for giving up was that they could not adhere to 47 patients (40.52%) because of treatment difficulties, 27 patients (23.28%) had poor curative effect, 19 patients (16.38%) were not intolerant of ventilator, and no symptoms were improved.
6125 cases of surgical treatment of patients, 86 cases (68.80%) by UPPP and modified UPPP; 17 cases (13.60%) with expansion nasal surgery (11.20%); 14 cases with simple tonsillectomy; 8 cases (6.40%) with other operation;
7, snoring and mild, 13.19% respectively, and the total prevalence of severe hypertension in patients with OSAHS 23.47%, 29.33%, 37.30%, 33.21%, associated with the severity of OSAHS, the prevalence rate of hypertension increased (2=40.40, P0.01); the total prevalence rate of hypertension in patients with OSAHS was significantly higher than that of simple snoring patients (P0.01).
8, simple snoring and mild, severe, and total OSAHS of patients receiving treatment rates were 25%, 35.68%, 44.71%, 64.96%, 55.68%, OSAHS increased with the severity of the treatment of patients with OSAHS rate was increased (x 2=116.70, P0.01); total OSAHS in patients was significantly higher than that of simple snoring patients (P0.01).
9, simple snoring and mild, severe, and total OSAHS in patients with hypertension group received treatment rates were 26.35%, 38%, 55.74%, 73%, 65.51%, hypertension group received treatment rates were 24.80%, 34.97%, 40.14%, 60.18%, 51.60%. simple snoring and mild OSAHS patients with hypertension group and non the hypertension group, receiving treatment there was no significant difference (P0.05); moderate, severe and total OSAHS patients with hypertension group were significantly higher than that of treatment group without hypertension (P0.05).
conclusion
1,44.32% OSAHS patients did not take any treatment measures. The lack of awareness of the risk of this disease is the main factor affecting the treatment. Breathing machine treatment is troublesome, fear of surgery, worry about the treatment effect, and the high cost of treatment is also an important factor.
2, nearly half of the patients who received CPAP treatment were probably related to the Department of respiratory medicine in our sleep monitoring room, but about 40% of patients treated with CPAP gave up CPAP treatment.
3, with the increase of the severity of OSAHS and the prevalence of hypertension, the rate of receiving treatment is also increasing.
4., the study confirmed the treatment status of OSAHS patients through long time and large sample observation. It shows that the treatment of OSAHS patients in China is not optimistic. We need to strengthen our understanding of the disease and improve the treatment effect.

【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R766

【參考文獻】

相關(guān)期刊論文 前8條

1 黃陸穎,余賢恩;肥胖與阻塞性睡眠呼吸暫停[J];國外醫(yī)學.呼吸系統(tǒng)分冊;2001年01期

2 雷志堅;梁碧芳;劉建紅;劉航;韋彩周;湯小軍;王豐;王曉源;劉凱;侯秀娟;;廣西城鄉(xiāng)人群對打鼾認知狀況調(diào)查[J];中國公共衛(wèi)生;2008年09期

3 董霄松,何權(quán)瀛,韓芳,魏海琳,陳爾璋,丁東杰;經(jīng)鼻持續(xù)氣道正壓通氣治療睡眠呼吸暫停綜合征的依從性及其影響因素[J];中華結(jié)核和呼吸雜志;2002年07期

4 上海市醫(yī)學會呼吸病學分會睡眠呼吸疾病學組;上海市30歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學調(diào)查[J];中華結(jié)核和呼吸雜志;2003年05期

5 何權(quán)瀛;阻塞性睡眠呼吸暫停低通氣綜合征對心腦血管的損害[J];中華全科醫(yī)師雜志;2005年04期

6 陳濘宏;莊立邦;周育廷;林士為;;阻塞型睡眠呼吸暫停低通氣綜合征及其并發(fā)癥[J];中華醫(yī)學雜志;2007年31期

7 趙陽;李建瑞;王利偉;魏永祥;付春華;楊非衡;肖明明;林莎;;北京市朝陽區(qū)成人打鼾及阻塞性睡眠呼吸暫停低通氣綜合征流行病學調(diào)查[J];中國醫(yī)藥導報;2013年27期

8 Srikant Nannapaneni;Kannan Ramar;Salim Surani;;Effect of obstructive sleep apnea on type 2 diabetes mellitus:A comprehensive literature review[J];World Journal of Diabetes;2013年06期

本文編號：1431494