本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + 多導(dǎo)睡眠監(jiān)測(cè)　； 參考：《吉林大學(xué)》2011年碩士論文

【摘要】：目的：分析床墊式睡眠監(jiān)測(cè)系統(tǒng)(MSMS)在阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)診斷中的意義。 方法：2010年6月至2010年12月就診于吉林大學(xué)中日聯(lián)誼醫(yī)院耳鼻咽喉頭頸外科的疑似OSAHS患者73例,采集臨床資料(年齡、性別、身高、體重、頸圍及Epworth嗜睡量表評(píng)分)分別經(jīng)過(guò)PSG和MSMS兩種監(jiān)測(cè)系統(tǒng)監(jiān)測(cè)睡眠,獲得睡眠監(jiān)測(cè)結(jié)果(PSG方法組和MSMS方法組)。根據(jù)2009年美國(guó)(AASM) OSAHS診斷指南中阻塞性睡眠呼吸暫停低通氣綜合征(obstructive sleep apnea hypopnea syndrome, OSAHS)診斷標(biāo)準(zhǔn),以PSG作為金標(biāo)準(zhǔn),分析MSMS方法診斷OSAHS的敏感性和特異性以及組間差異。分析MSMS監(jiān)測(cè)系統(tǒng)中AHI指數(shù)與臨床參數(shù)(年齡、性別、體重指數(shù)、頸圍等)的相關(guān)性。 結(jié)果：1分析性別、年齡與OSAHS患者發(fā)病的相關(guān)性。73例疑似OSAHS患者其中男59例,女14例,性別比為4.2：1,年齡20-77歲,平均(46.22±9.99)歲。PSG檢測(cè)結(jié)果為AHI為1.20～95.80次/h,平均為(39.798±25.77)次/h。按性別(男、女)、年齡(18～39組,40～59組,60組)分組比較患者的AHI嚴(yán)重程度(正常、輕度、中度、重度),發(fā)現(xiàn)各組間AHI有顯著性差異(P0.05),其中以中青年男性發(fā)病率最高,病情最重。 2應(yīng)用相關(guān)性方程Pearson分析NC、BMI與AHI之間的相關(guān)性。73例受檢者的頸圍(NC)為(30～48)cm,平均(40.715±4.421)cm,體重指數(shù)(BMI)為17.1～39kg/m2,平均(28.292±4.353)kg/m2。AHI為(1.20～95.80)次/h,平均為(39.798±25.77)次/h。①BMI與AHI相關(guān)性比較,認(rèn)為兩者之間存在正相關(guān)關(guān)系(P0.05)。②同樣方法將NC與AHI兩者進(jìn)行雙變量相關(guān)性比較,認(rèn)為NC與AHI兩者之間存在正相關(guān)關(guān)系(P0.05),且NC與AHI之間相關(guān)性更大。 3 OSAHS患者Epworth嗜睡量表(ESS)的評(píng)分(EP)與AHI輕重程度之間進(jìn)行相關(guān)性分析：采用非參數(shù)多樣本秩和檢驗(yàn)(Kruskal-Wallis法,即H檢驗(yàn))分析比較ESS嗜睡程度(正常、輕度嗜睡、中度嗜睡、重度嗜睡)與AHI的嚴(yán)重程度(正常、輕度、中度、重度)。發(fā)現(xiàn)重度OSAHS組稍高于正常以及輕、中度OSAHS組的ESS中位數(shù)值,分析發(fā)現(xiàn)重度OSAHS組與其他各組間差異有統(tǒng)計(jì)學(xué)意義。 4 PSG與MSMS檢測(cè)結(jié)果比較：本實(shí)驗(yàn)中73例受檢者經(jīng)PSG監(jiān)測(cè)的AHI為1.20～95.80次/h,平均為(39.798±25.77)次/h。隔夜行MSMS監(jiān)測(cè)的AHI為2.00～105.10次/h,平均為(42.193±26.92)次/h。以AHI5為陽(yáng)性診斷指標(biāo)：PSG方法檢驗(yàn)陽(yáng)性68例,MSMS方法檢驗(yàn)陽(yáng)性70例,兩者同為陰性3例,兩者同為陽(yáng)性68例。以PSG陽(yáng)性為金標(biāo)準(zhǔn),MSMS方法的靈敏度為100%,特異度為90%,采用配對(duì)χ2檢驗(yàn)的方法比較兩種方法,發(fā)現(xiàn)兩種方法診斷OSAHS無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。根據(jù)AHI值將受檢者進(jìn)行分組：PSG組(正常5例,輕度14例,中度13例,重度41例)、MSMS組(正常3例,輕度13例,中度15例,重度42例),應(yīng)用行×列表資料的χ2檢驗(yàn)方法比較兩種檢測(cè)方法的構(gòu)成比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：1.本實(shí)驗(yàn)結(jié)果顯示床墊系統(tǒng)判斷OSAHS患者的AHI的靈敏度為100.0%,特異度為90%。微動(dòng)敏感床墊對(duì)阻塞性呼吸事件的敏感度高于PSG結(jié)果床墊系統(tǒng)是用于睡眠呼吸疾病的篩查和臨床診斷的重要方法。 2.本研究結(jié)果顯示ESS評(píng)分可以從一個(gè)側(cè)面顯示病情程度的變化,它聯(lián)合睡眠床墊,為OSAHS診斷提供較客觀的臨床依據(jù),也為患者提供一個(gè)簡(jiǎn)便、易行的自評(píng)工具。 3.體重指數(shù)(BMI)、頸圍(NC)都是衡量肥胖的參數(shù)。頸圍更能直接反應(yīng)頸部脂肪的情況,是目前反映睡眠時(shí)上氣道口徑及功能最特異的指標(biāo),頸圍增粗的睡眠打鼾者可視為OSAHS的高危人群。
[Abstract]:Objective: to analyze the significance of mattress sleep monitoring system (MSMS) in the diagnosis of obstructive sleep apnea hypopnea syndrome (OSAHS).
Methods: from June 2010 to December 2010, 73 suspected OSAHS patients were diagnosed at the otorhinolaryngology head and neck surgery of the Sino Japanese Friendship Hospital of Jilin University. The clinical data (age, sex, height, weight, neck circumference and Epworth sleepiness scale score) were monitored by two monitoring systems of PSG and MSMS, and the results of sleep monitoring were obtained (PSG method group and MSMS method group. Based on the diagnostic criteria of obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea hypopnea syndrome, OSAHS) in the 2009 American (AASM) OSAHS diagnostic guide and PSG as a gold standard, the sensitivity and specificity of MSMS method in the diagnosis of OSAHS and the difference between groups were analyzed. Correlation between clinical parameters (age, sex, body mass index, neck circumference, etc.).
Results: 1 the correlation between sex, age and the incidence of OSAHS patients was.73 cases of suspected OSAHS patients, including 59 males and 14 females, sex ratio was 4.2:1, age 20-77 years, and the average (46.22 + 9.99) years old.PSG test results were 1.20 to 95.80 /h, the average was (39.798 + 25.77) / h. by sex (male, female), age (18~39, 40~59, 60) groups. The severity of AHI (normal, mild, moderate, severe) was compared to the patients. There was a significant difference in AHI (P0.05) among the groups. Among them, the incidence of the middle and young men was the highest and the disease was the most serious.
2 the correlation equation Pearson analysis NC, the correlation between BMI and AHI, the neck circumference (NC) of the examiner was (30~48) cm, the average (40.715 + 4.421) cm, and the body mass index (BMI) was 17.1 ~ 39kg/m2, the average (28.292 + 4.353) kg/m2.AHI was (1.20 to 95.80) /h, and the average was (39.798 + 25.77). In the positive correlation (P0.05). (2) the same method compares the bivariate correlation between NC and AHI. It is considered that there is a positive correlation between NC and AHI (P0.05), and the correlation between NC and AHI is greater.
The correlation analysis between 3 OSAHS patients' Epworth sleepiness scale (ESS) score (EP) and the severity of AHI: an analysis of the severity of ESS somnolence (normal, mild sleepiness, moderate sleepiness, severe sleepiness) and AHI (normal, mild, moderate, severe) by non parametric multisample rank sum test (Kruskal-Wallis, or H test). The median ESS values in group OSAHS were slightly higher than those in normal, mild and moderate OSAHS groups, and the difference between severe OSAHS group and other groups was statistically significant.
4 PSG and MSMS test results: in this experiment, 73 cases of PSG monitored by AHI were 1.20 to 95.80 times /h, and the average (39.798 + 25.77) /h. septum MSMS monitoring was 2 to 105.10 times /h, and the average was (42.193 + 26.92) /h. with AHI5 as positive diagnostic index: PSG square test was positive and positive 70 cases were tested. Both The same was negative in 3 cases, both were positive in 68 cases, with PSG positive as gold standard, the sensitivity of MSMS method was 100%, the specificity was 90%, two methods were compared by paired chi 2 test, and two methods were found to have no statistical significance (P0.05). According to the AHI value, the subjects were grouped in PSG group (normal 5 cases, mild 14 cases, and moderate 13 cases,) Severe 41 cases), group MSMS (normal 3 cases, mild 13 cases, moderate 15 cases, 42 severe cases), the x 2 test method of using X list data was used to compare the composition of two detection methods with no statistically significant difference (P0.05).
Conclusion: 1. the results of the 1. experiments show that the sensitivity of the mattress system to determine the AHI of the OSAHS patients is 100%. The sensitivity of the specificity of the mattress is higher than that of the 90%. microdynamic mattress. The sensitivity of the mattress is higher than the PSG result mattress system is an important method for the screening and clinical diagnosis of sleep respiratory diseases.
2. the results of the study show that the ESS score can show the changes in the degree of the disease from one side. It combined with sleep mattress, provides a more objective clinical basis for the diagnosis of OSAHS, and provides a simple and easy self-assessment tool for the patients.
The 3. body mass index (BMI) and neck circumference (NC) are all parameters for measuring obesity. The neck circumference can reflect the neck fat more directly. It is the most specific indicator of the upper airway diameter and function at present, and the roughened snorers in the neck circumference can be regarded as the high-risk group of OSAHS.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R766.4

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相關(guān)期刊論文 前3條

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本文編號(hào)：1835868