本文選題：阻塞性睡眠呼吸暫停綜合征 + 心率變異性　； 參考：《昆明醫(yī)學(xué)院》2010年碩士論文

【摘要】： 目的:探討阻塞性睡眠呼吸暫停綜合征(OSAS)患者心率變異性與心律失常發(fā)生的相關(guān)性,進(jìn)而預(yù)測(cè)OSAS患者心律失常的發(fā)生,為監(jiān)測(cè)和評(píng)估抗心律失常藥物療效有價(jià)值的臨床參考信息,預(yù)防和治療心律失常提供新的思路。 方法:以2009年2月至2010年2月我院門診和住院81例患者為研究對(duì)象,對(duì)所有患者進(jìn)行一般情況,多導(dǎo)睡眠圖監(jiān)測(cè)和24小時(shí)動(dòng)態(tài)心電圖監(jiān)測(cè)。入選患者經(jīng)病史、體檢、超聲心動(dòng)圖和血生化檢查,排除風(fēng)濕性瓣膜性心臟病、先天性心臟病、中樞型睡眠呼吸暫停綜合征(CSAS)、長(zhǎng)期嚴(yán)重酗酒、嚴(yán)重肺部疾病、腎臟、腦部疾病,且近期無服用輔助睡眠的藥物。據(jù)多導(dǎo)睡眠圖監(jiān)測(cè),按睡眠呼吸暫停低通氣指數(shù)(AHI)超過5次以上,對(duì)標(biāo)準(zhǔn)將受試者分為OSAS組(實(shí)驗(yàn)組)和無OSAS組(對(duì)照組)兩組,其中實(shí)驗(yàn)組48例,男37例,女11例,年齡58-93(69.7±8.8)歲;對(duì)照組33例,男23例,女10例,年齡59-89(69.8±8.5)歲。對(duì)兩組人群分別進(jìn)行超聲心動(dòng)圖檢測(cè)心臟結(jié)構(gòu)指標(biāo),24小時(shí)動(dòng)態(tài)心電圖監(jiān)測(cè)獲得心率變異性指標(biāo)及心律失常指標(biāo),所有實(shí)驗(yàn)數(shù)據(jù)采用SPSSStatistics 17.0軟件包處理分析,計(jì)量資料以均值±標(biāo)準(zhǔn)差((?)±s)表示,計(jì)數(shù)資料以頻數(shù)表示。組間定量資料比較采用t檢驗(yàn),定性資料比較采用X~2檢驗(yàn),P＜0.05為差異有統(tǒng)計(jì)學(xué)意義。自變量和因變量之間相關(guān)分析,雙變量為計(jì)量資料,成正態(tài)分布的,行線性相關(guān)分析(計(jì)算Pearson相關(guān)系數(shù)),對(duì)分類變量的數(shù)據(jù)或變量值的分布明顯非正態(tài)或分布不明時(shí),行秩相關(guān)法(計(jì)算Spearman相關(guān)系數(shù))。在存在相關(guān)關(guān)系時(shí),r≥0.7,兩變量有高度相關(guān)關(guān)系;0.7＞r≥0.4,兩變量有中度相關(guān)關(guān)系;r＜0.4,兩變量有低度相關(guān)關(guān)系。 結(jié)果:總體比較實(shí)驗(yàn)組與對(duì)照組在性別、年齡、身高、體重、體重指數(shù)(BMI)、腰圍、臀圍、腰臀比(WHR)、吸煙、飲酒、合并高血壓病情況、血壓(收縮壓/舒張壓)水平、高血壓病程、降壓藥使用情況、合并糖尿病情況、空腹血糖(FPG)、餐后血糖(PPBS)、合并退行性心臟瓣膜病情況相比較均無統(tǒng)計(jì)學(xué)差異(P＞0.05)。而實(shí)驗(yàn)組頸圍(Nc)和血液生化指標(biāo)比較中的低密度脂蛋白膽固醇(LDL-c)及高敏C反應(yīng)蛋白(hs-CRP)明顯高于對(duì)照組(Nc:40.88±3.62 cm vs 38.12±3.45 cm;LDL-c:3.78±0.80 mmol/L vs2.99±0.89 mmol/L:hs-CRP:15.19±8.97 mmol/L vs9.42±1.92mmol/L),而高密度脂蛋白膽固醇(HDL-c)低于對(duì)照組(0.89±0.21 mmol/L vs1.10±0.23mmol/L),比較均有統(tǒng)計(jì)學(xué)差異(P＜0.05)。心臟結(jié)構(gòu)指標(biāo)中,實(shí)驗(yàn)組左心房?jī)?nèi)徑(LAId)、右心房?jī)?nèi)徑(RAId)、室間隔厚度(IVST)、左心室舒張末期內(nèi)徑(LVPWT)、左室肌重量(LVM)、左室肌重量指數(shù)(LVMI)均高于對(duì)照組,比較均有統(tǒng)計(jì)學(xué)差異(P＜0.05);心率變異性指標(biāo)中,實(shí)驗(yàn)組R-R間期的標(biāo)準(zhǔn)差(SDNN)、5 min平均R-R間期的標(biāo)準(zhǔn)差(SDANN)低于對(duì)照組,比較均有統(tǒng)計(jì)學(xué)差異(P＜0.05);心律失常發(fā)生情況比較,實(shí)驗(yàn)組患者的心律失常(Arrhythmia)人數(shù)顯著高于對(duì)照組,其中在最慢心率、最快心率、平均心率、心房顫動(dòng)、心房撲動(dòng)、竇性停搏、束支傳導(dǎo)阻滯上比較無差異;實(shí)驗(yàn)組室性早搏、成對(duì)室性早搏、室性心動(dòng)過速、室上性早搏、成對(duì)室上性早搏、室上性心動(dòng)過速、房室傳導(dǎo)阻滯發(fā)生率較對(duì)照組高,比較均有統(tǒng)計(jì)學(xué)差異(P＜0.05)。相關(guān)分析提示:心臟結(jié)構(gòu)指標(biāo)與缺氧時(shí)間指標(biāo)成中度相關(guān),與缺氧程度指標(biāo)成中度相關(guān),與缺氧綜合指標(biāo)成中度相關(guān);心律失常發(fā)生與缺氧時(shí)間及缺氧程度成低到中度相關(guān);心率變異性指標(biāo)與心律失常發(fā)生成低到中度相關(guān)。 結(jié)論:OSAS患者的心律失常發(fā)生率較無OSAS患者更為嚴(yán)重,與患者長(zhǎng)期間歇性低氧血癥和高碳酸血癥相關(guān)的心臟結(jié)構(gòu)改變、體液因子變化、自主神經(jīng)功能紊亂等因素有關(guān)。本研究報(bào)道了OSAS患者心臟結(jié)構(gòu)發(fā)生改變、心率變異性指標(biāo)與心律失常發(fā)生具有相關(guān)性,這些研究結(jié)果可為臨床評(píng)估OSAS患者發(fā)生心律失常風(fēng)險(xiǎn)、指導(dǎo)抗心律失常藥物療效的監(jiān)測(cè)、改善頑固性心律失常的診療思路提供有價(jià)值的參考信息。
[Abstract]:Objective: To investigate the correlation between heart rate variability and arrhythmia in patients with obstructive sleep apnea syndrome (OSAS), and then to predict the occurrence of arrhythmia in OSAS patients, and to provide valuable information for monitoring and evaluating the efficacy of antiarrhythmic drugs, and to provide new ideas for preventing and treating arrhythmia.
Methods: 81 patients in our hospital from February 2009 to February 2010 were studied. The general situation, polysomnography monitoring and 24 hour ambulatory electrocardiogram monitoring were carried out for all patients. The patients were selected by medical history, physical examination, echocardiography and blood biochemical examination, excluding rheumatic valvular heart disease, congenital heart disease, central type sleep. Sleep apnea syndrome (CSAS), long term serious alcoholism, severe lung disease, kidney, brain disease, and no use of auxiliary sleep drugs in the near future. According to polysomnography monitoring, according to sleep apnea hypopnea index (AHI) more than 5 times, the standard subjects were divided into group OSAS (experimental group) and no OSAS group (control group), which was real There were 48 cases, 37 males and 11 females, 58-93 (69.7 + 8.8) years old, 33 cases in the control group, 23 men, 10 cases, 59-89 (69.8 + 8.5) years old. Echocardiography was used to detect cardiac structural indexes in the two groups, and the heart rate variability index and arrhythmia indexes were obtained by ambulatory electrocardiogram monitoring. All experimental data were SPSSStatistics 17 software package analysis, the measurement data were expressed with mean mean standard deviation ((?) + s), and the count data were expressed in frequency. The quantitative data between groups were compared with t test, qualitative data were compared with X~2 test, P < 0.05 was statistically significant. The correlation analysis between independent variables and dependent variables, bivariate as measurement data, normal distribution, line line Sex correlation analysis (calculation of Pearson correlation coefficient), when the distribution of data or variable values of classified variables is obviously unnormal or unidentified, the line rank correlation method (calculated Spearman correlation coefficient). In the presence of correlation, R > 0.7, two variables have high correlation; 0.7 > R > 0.4, two variables have moderate correlation; R < 0.4, two variable is low Degree correlation.
Results: the overall comparison between the experimental group and the control group was in sex, age, height, weight, body mass index (BMI), waist circumference, hip circumference, waist to hip ratio (WHR), smoking, drinking, hypertension, blood pressure (systolic pressure / diastolic pressure), hypertension course, use of antihypertensive drugs, combined diabetes, fasting blood glucose (FPG), postprandial blood glucose (PPBS), combined regression. There was no significant difference in the conditions of cardiac valvular heart disease (P > 0.05). The low density lipoprotein cholesterol (LDL-c) and the high sensitive C reactive protein (hs-CRP) in the comparison of neck circumference (Nc) and blood biochemical indexes in the experimental group were significantly higher than those in the control group (Nc:40.88 + 3.62 cm vs 38.12 + 3.45 cm; LDL-c:3.78 + 0.80 mmol/L vs2.99 0.89 0.89 19 + 8.97 mmol/L vs9.42 + 1.92mmol/L), while high density lipoprotein cholesterol (HDL-c) was lower than that of the control group (0.89 + 0.21 mmol/L vs1.10 + 0.23mmol/L), and there were statistically significant differences (P < 0.05). The left atrium diameter (LAId), right atrium diameter (RAId), ventricular septum thickness (IVST), and the left ventricular end diastolic diameter (LVPWT) were in the experimental group. The weight of left ventricular muscle (LVM) and left ventricular muscle weight index (LVMI) were all higher than those in the control group (P < 0.05). In the heart rate variability index, the standard deviation of the R-R interval of the experimental group (SDNN), the standard deviation of the average R-R interval of the 5 min (SDANN) were lower than that of the control group (P < 0.05), and the occurrence of arrhythmia was compared. The number of patients with arrhythmia (Arrhythmia) was significantly higher than that in the control group, of which there were no differences in the slowest heart rate, the fastest heart rate, the average heart rate, atrial fibrillation, atrial flutter, sinus arrest, and bundle branch block, and experimental ventricular premature beat, ventricular premature beat, ventricular tachycardia, supraventricular sexual premature beat, supraventricular sex, and supraventricular sex. The incidence of atrioventricular block was higher than that of the control group (P < 0.05). The correlation analysis showed that the cardiac structural index was moderately correlated with the hypoxia time index, moderately related to the hypoxia index and moderate correlation with the hypoxia comprehensive index, and the occurrence of arrhythmia was lower to the hypoxic time and the degree of hypoxia. Heart rate variability was associated with low and moderate cardiac arrhythmias.
Conclusion: the incidence of arrhythmia in OSAS patients is more severe than that in non OSAS patients. It is related to cardiac structural changes, changes of body fluid factors and autonomic nervous dysfunction associated with chronic intermittent hypoxemia and hypercapnia. This study reports the changes in cardiac structure, heart rate variability and arrhythmia in OSAS patients. These results can be used to evaluate the risk of arrhythmia in OSAS patients, to guide the monitoring of the efficacy of antiarrhythmic drugs and to provide valuable information for improving the diagnosis and treatment of intractable arrhythmia.

【學(xué)位授予單位】：昆明醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R541.7;R766

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 蘇紅,陳學(xué)遠(yuǎn),張建全,李國(guó)秀,鄧靜敏;阻塞性睡眠呼吸暫停低通氣綜合征血管活性物質(zhì)失衡的研究[J];廣西醫(yī)科大學(xué)學(xué)報(bào);2004年03期

2 黃文,呂芳芳,史繼紅,孫全格;阻塞性睡眠呼吸暫停綜合征患者心律失常的臨床分析[J];山東大學(xué)基礎(chǔ)醫(yī)學(xué)院學(xué)報(bào);2004年03期

3 張丙芳,謝文,范風(fēng)云解放軍第四軍醫(yī)大學(xué)西京醫(yī)院放療科,張彩蓮,宋立強(qiáng),戚好文;睡眠呼吸暫停綜合征患者血壓及血管活性物質(zhì)的變化[J];中國(guó)臨床康復(fù);2004年36期

4 周辰,張希龍,戎娟;氣道正壓通氣治療對(duì)阻塞性睡眠呼吸暫�；颊哐焊吣隣顟B(tài)的影響[J];江蘇醫(yī)藥;2004年07期

5 孟凌新!110003沈陽市,崔健君!110003沈陽市,孔娟!110003沈陽市;缺氧適應(yīng)對(duì)缺血缺氧腦組織一氧化氮和內(nèi)皮素的影響[J];中華麻醉學(xué)雜志;1999年07期

，

本文編號(hào)：1887835