本文選題：睡眠呼吸暫停低通氣綜合征 + 子癇前期��； 參考：《南方醫(yī)科大學(xué)》2010年碩士論文

【摘要】：背景 隨著睡眠研究的深入,人們不僅了解到睡眠對(duì)人類(lèi)的重要性,而且逐步了解到不正常的睡眠對(duì)人類(lèi)所產(chǎn)生的重大的影響。人的一生有1／3是在睡眠中度過(guò)的,在這1／3的夜色中,發(fā)生于睡眠中的眾多現(xiàn)象如做夢(mèng)、夢(mèng)游、失眠等睡眠障礙性疾患雖早就引起醫(yī)務(wù)人員的注意,但人們未給予重視,至于睡眠對(duì)其他疾病的影響人們更是知之甚少。生活中常常有這些情況發(fā)生：一個(gè)素來(lái)健康的朋友在睡眠中莫名其妙的突然去世；一些不明原因的原發(fā)性高血壓患者,一輩子痛苦的過(guò)著藥罐子的生活；殊不知這些意外的死亡或不明原因的常見(jiàn)疾病很可能與睡眠中司空見(jiàn)慣的一種現(xiàn)象——打鼾及呼吸暫停有關(guān)。 隨著人們對(duì)睡眠的進(jìn)一步認(rèn)識(shí)及傳感記錄技術(shù)的發(fā)展,從20世紀(jì)70年代在世界范圍內(nèi)將睡眠呼吸紊亂作為一種疾病予以關(guān)注并認(rèn)真研究的。睡眠呼吸紊亂(Sleep Disorder Breathion,SDB)包括單純性鼾癥、肥胖低通氣綜合征、睡眠呼吸暫停低通氣綜合征、上氣道阻力綜合征,其中睡眠呼吸暫停低通氣綜合征(Sleep Apnea Hypopnea Syndrom,SAHS)分為阻塞性睡眠呼吸暫停低通氣綜合征(Obstructive Sleep Apnea Hypopnea Syndrom,OSAHS)、中樞性睡眠呼吸暫停低通氣綜合征(Central Sleep Apnea Hypopnea Syndrom,CSAHS)、混合性睡眠呼吸暫停低通氣綜合征(Mixed Sleep Apnea Hypopnea Syndrom,MSAHS)。我國(guó)SAHS的研究從無(wú)到有,從局部地區(qū)發(fā)展到全國(guó),走過(guò)了近20年的歷史,最初階段是一些開(kāi)拓與探索性工作,真正的發(fā)展是近幾年的事情,隨著睡眠試驗(yàn)室數(shù)量的增加,被診治的患者數(shù)量有了相應(yīng)的增加,診治技術(shù)不斷地提高,開(kāi)展了與SAHS相關(guān)學(xué)科領(lǐng)域的科研工作,包括基礎(chǔ)與臨床研究,流行病學(xué)調(diào)查等,目前已研究證實(shí)SAHS是導(dǎo)致高血壓的獨(dú)立危險(xiǎn)因素。睡眠呼吸暫停低通氣綜合征主要表現(xiàn)為睡眠時(shí)打鼾并伴有呼吸暫停和呼吸表淺,夜間反復(fù)發(fā)生低氧血癥、高碳酸血癥和睡眠結(jié)構(gòu)紊亂,導(dǎo)致白天嗜睡,工作效率降低等,且常并發(fā)心腦血管疾病,嚴(yán)重影響患者的生活質(zhì)量和壽命。學(xué)者研究發(fā)現(xiàn)SAHS患者夜間反復(fù)缺氧及再灌注導(dǎo)致血清中炎癥因子(IL-6、TNF-a等)明顯增高并進(jìn)一步導(dǎo)致高血壓等疾病的發(fā)生。 妊娠高血壓疾病是妊娠期特有以高血壓為主要臨床表現(xiàn)的疾病,其發(fā)病率達(dá)10.5%,而子癇前期是妊娠期高血壓疾病中一經(jīng)診斷均需住院治療的更為嚴(yán)重的一個(gè)發(fā)展階段,是孕產(chǎn)婦和圍生兒發(fā)病率及死亡率的主要原因,如何及早發(fā)現(xiàn)、積極預(yù)防和干預(yù)是產(chǎn)科醫(yī)務(wù)工作者一直在探索的問(wèn)題,至今子癇前期病因及發(fā)病機(jī)制尚未完全闡明,雖然建立了胎盤(pán)缺血學(xué)說(shuō),血管內(nèi)皮損傷學(xué)說(shuō),免疫學(xué)說(shuō)和遺傳學(xué)說(shuō)等。但還只是停留在學(xué)說(shuō)上,多數(shù)學(xué)者研究發(fā)現(xiàn)子癇前期患者血清中炎癥因子(IL-6、TNF-a)明顯高于正常妊娠者,且與子癇前期疾病病情的嚴(yán)重程度呈明顯相關(guān)性；Williams等研究發(fā)現(xiàn)子癇前期患者在臨床癥狀出現(xiàn)之前就已有外周血及羊水中TNF-a及其受體含量的顯著升高。但炎癥因子增多的原因尚不清楚。 IL-6與TNF-a都是近10余年來(lái)發(fā)現(xiàn)的細(xì)胞因子,它們均具有廣泛的生物學(xué)活性。在正常妊娠時(shí)均維持在較低水平,調(diào)節(jié)胎盤(pán)組織的正常生長(zhǎng)和功能發(fā)揮,參與正常妊娠的維持,促進(jìn)滋養(yǎng)層細(xì)胞的增殖和侵襲性,增加子宮胎盤(pán)血供,促進(jìn)胎兒生長(zhǎng)發(fā)育及調(diào)節(jié)母胎之間的免疫調(diào)節(jié)。TNF-a和IL-6持續(xù)增高可導(dǎo)致人體病理?yè)p害的發(fā)生,如促進(jìn)內(nèi)皮細(xì)胞黏附白細(xì)胞,刺激內(nèi)皮細(xì)胞分泌炎性介質(zhì),激活凝血系統(tǒng)、抑制纖溶,增加炎性滲出和氧自由基的產(chǎn)生,促進(jìn)細(xì)胞黏附分子的表達(dá)等等,進(jìn)一步導(dǎo)致血管收縮痙攣,血壓增高,影響腎臟血管,導(dǎo)致蛋白尿的出現(xiàn)。 近幾年國(guó)外多數(shù)學(xué)者研究發(fā)現(xiàn)SAHS與子癇前期、宮內(nèi)胎兒生長(zhǎng)受限、早產(chǎn)等有明顯相關(guān)性,且對(duì)存在SAHS的孕婦給予nCPAP治療后可明顯降低子癇前期患者的血壓并生產(chǎn)出正常體重胎兒。 我們發(fā)現(xiàn)SAHS與子癇前期有眾多重疊因素如：均有炎癥因子及氧化應(yīng)激產(chǎn)物水平的升高,上氣道狹窄、腹型肥胖等使胸廓活動(dòng)度減小的因素存在,內(nèi)分泌的的變化等等,另外臨床表現(xiàn)都有高血壓、夜間片段睡眠、白天嗜睡等表現(xiàn)。鑒于以上研究的基礎(chǔ)及國(guó)際上認(rèn)可的SAHS診斷手段——多導(dǎo)睡眠監(jiān)測(cè),我們對(duì)入選的患者進(jìn)行多導(dǎo)睡眠監(jiān)測(cè)以評(píng)估其是否存在SAHS,并從炎癥因子水平初步探討SAHS與子癇前期之間相關(guān)性及炎癥因子在其可能的發(fā)病機(jī)制中的作用,另外對(duì)于存在SAHS的患者給予國(guó)際認(rèn)可的治療SAHS的有效方法之一——持續(xù)氣道正壓通氣治療,并觀察治療效果以進(jìn)一步證實(shí)SAHS與子癇前期之間的相關(guān)性。 第一章炎癥因子水平初步觀察并探討SAHS與子癇前期的相關(guān)性 目的 通過(guò)檢測(cè)血清中的炎癥因子水平初步觀察并探討SAHS與子癇前期的相關(guān)性。 方法 1、病例與分組選取2008年7月～2009年6月在重癥孕產(chǎn)婦救治醫(yī)院產(chǎn)檢并住院分娩的符合納入標(biāo)準(zhǔn)的子癇前期孕婦及同期入院產(chǎn)檢的年齡、孕齡無(wú)顯著差異的正常孕婦,對(duì)其均進(jìn)行整晚的多導(dǎo)睡眠監(jiān)測(cè)(Polysomnogram,PSG),其中正常妊娠組25例,子癇前期無(wú)SAHS組43例,子癇前期并SAHS組27例。以上孕婦均為單胎妊娠,且既往無(wú)高血壓、心臟病、腎病、糖尿病和慢性肺部疾病等可引起低氧的疾病。 2、睡眠監(jiān)測(cè)對(duì)入選的孕婦均進(jìn)行整晚至少7h的多導(dǎo)睡眠監(jiān)測(cè),監(jiān)測(cè)內(nèi)容包括：腦電、眼電、下頜肌電、心電、口鼻氣流、鼾聲、體位、胸腹運(yùn)動(dòng)和血氧飽和度。多導(dǎo)睡眠監(jiān)測(cè)(PSG)監(jiān)測(cè)的數(shù)據(jù)先后經(jīng)電腦自動(dòng)分析和人工校正,參考中華醫(yī)學(xué)會(huì)制定的《阻塞性睡眠呼吸暫停低通氣綜合征診治指南(草案)》成人SAHS診斷標(biāo)準(zhǔn),其中AHI作為主要判斷標(biāo)準(zhǔn),LSaO2作為參考,做出是否存在SAHS及其嚴(yán)重程度的診斷。 3、血壓測(cè)量于睡眠監(jiān)測(cè)結(jié)束后平臥10分鐘,采用立式水銀柱袖帶式血壓計(jì)(上海醫(yī)用設(shè)備廠(chǎng)生產(chǎn))測(cè)量血壓,為方便比較,取其平均動(dòng)脈壓(Mean Arterial Pressure,MAP), MAP=舒張壓+1／3(收縮壓—舒張壓)。 4、24小時(shí)尿蛋白定量測(cè)定收集7Am以后至次日7Am共24小時(shí)尿液,采用考馬斯亮藍(lán)G25O4法測(cè)定24小時(shí)尿蛋白并作記錄。 5、血清IL-6和TNF-a檢測(cè)于第二日清晨睡眠監(jiān)測(cè)完畢醒后靜臥10分鐘靜脈采血6ml,放于4℃冰箱中待分離,3000r／min離心10min,分離血清并分裝于EP管中,-80℃保存待檢。血清TNF-a和IL-6水平的檢測(cè)采用酶聯(lián)免疫吸附試驗(yàn)(Enzyme-Linked Immunosorbnent Assay, ELISA),試劑盒由武漢博士德公司提供,檢測(cè)方法嚴(yán)格按照說(shuō)明書(shū)進(jìn)行操作。 6、統(tǒng)計(jì)分析采用統(tǒng)計(jì)軟件SPSS13.0進(jìn)行統(tǒng)計(jì)學(xué)處理和分析。試驗(yàn)數(shù)據(jù)計(jì)量資料采用均數(shù)加減標(biāo)準(zhǔn)差(x±SD)表示。組間比較采用One-Way ANOVA,兩組間比較采用LSD檢驗(yàn),相關(guān)性分析采用Pearson。所有統(tǒng)計(jì)數(shù)據(jù)以P0.05作為有顯著性差異的界限。 結(jié)果 1、一般資料組間年齡(27.5±6.0 vs 29.0±5.3 vs 29.2±5.0,P0.05)、孕齡(31.1±4.9 vs 31.0±4.0 vs 30.6±4.6,P0.05)比較無(wú)顯著性差異,具有可比性。 2、組間臨床及試驗(yàn)室指標(biāo)統(tǒng)計(jì)學(xué)分析 三組間體重量指數(shù)(BMI)、平均動(dòng)脈壓(MAP)、24h尿蛋白定量、睡眠呼吸暫停低通氣指數(shù)(AHI)、最低血氧飽和度(LSaO2)、IL-6及TNF-a水平有顯著差異(P0.01)。但子癇前期無(wú)SAHS組與子癇前期并SAHS組BMI無(wú)顯著差異(P=0.083)。正常妊娠組和子癇前期無(wú)SAHS組比較AHI和LSaO2無(wú)顯著差異(P=0.797,0.862)； 子癇前期兩個(gè)重要的臨床指標(biāo)血壓和24h尿蛋白定量與SAHS的嚴(yán)重程度呈顯著的相關(guān)性(P0.01)；與炎癥因子指標(biāo)IL-6及TNF-a相關(guān)系數(shù)更大,IL-6和TNF-a與AHI和LSaO2也有顯著相關(guān)性。同時(shí)發(fā)現(xiàn)血壓和尿蛋白與BMI有一定的相關(guān)性,但相關(guān)性較弱。 結(jié)論 1、子癇前期孕婦夜間發(fā)生睡眠呼吸暫停低通氣的次數(shù)較正常妊娠婦女明顯增多,說(shuō)明子癇前期孕婦發(fā)生SAHS的機(jī)率相對(duì)增加。 2、炎癥因子(IL-6和TNF-a)可能在子癇前期合并SAHS的發(fā)病機(jī)制中起到重要的作用。 3、SAHS可能是導(dǎo)致子癇前期疾病發(fā)生和發(fā)展的一個(gè)危險(xiǎn)因素。 第二章AutoCPAP治療子癇前期合并SAHS患者療效觀察 目的 通過(guò)對(duì)合并SAHS的子癇前期孕婦進(jìn)行AutoCPAP治療觀察治療效果及進(jìn)一步證實(shí)SAHS與子癇前期間的相關(guān)性。 方法 1、病例選取經(jīng)多導(dǎo)睡眠監(jiān)測(cè)證實(shí)存在SAHS的孕婦27例,再次統(tǒng)計(jì)其年齡、孕齡、BMI等基本資料。 2、AutoCPAP治療對(duì)經(jīng)過(guò)多導(dǎo)睡眠監(jiān)測(cè)證實(shí)符合SAHS診斷標(biāo)準(zhǔn)的孕婦給予進(jìn)一步解釋AutoCPAP治療的一些相關(guān)情況,并簽知情同意書(shū),每天給予至少4小時(shí)的治療,向患者詳細(xì)解釋該呼吸機(jī)的使用方法、面罩佩戴問(wèn)題及使用過(guò)程中可能出現(xiàn)的問(wèn)題及解決方法,在患者完全明白后開(kāi)始給予治療,因多數(shù)患者在起初使用時(shí)不太適應(yīng),所以給予延遲30分鐘升壓并給予濕化以使患者慢慢適應(yīng)至接受。呼吸機(jī)壓力范圍定在4～20cmH2O。 3、血壓測(cè)量于睡眠監(jiān)測(cè)結(jié)束后平臥10分鐘,采用立式水銀柱袖帶式血壓計(jì)(上海醫(yī)用設(shè)備廠(chǎng)生產(chǎn))測(cè)量血壓,為方便比較,取其平均動(dòng)脈壓(Mean Arterial Pressure,MAP),MAP=舒張壓+1／3(收縮壓—舒張壓)。 4、24小時(shí)尿蛋白定量測(cè)定收集7Am以后至次日7Am共24小時(shí)尿液,采用考馬斯亮藍(lán)G25O4法測(cè)定24小時(shí)尿蛋白并作記錄。 5、血清IL-6和TNF-a檢測(cè)于第七日清晨AutoCPAP治療療程完畢醒后靜臥10分鐘靜脈采血6ml,放于4℃冰箱中待分離,3000r／min離心10min,分離血清并分裝于EP管中,-80℃保存待檢。血清TNF-a和IL-6水平的檢測(cè)采用酶聯(lián)免疫吸附試驗(yàn),試劑盒由武漢博士德公司提供,檢測(cè)方法嚴(yán)格按照說(shuō)明書(shū)進(jìn)行操作。 6、統(tǒng)計(jì)學(xué)分析采用統(tǒng)計(jì)軟件SPSS13.0進(jìn)行統(tǒng)計(jì)學(xué)處理和分析。試驗(yàn)數(shù)據(jù)計(jì)量資料采用均數(shù)加減標(biāo)準(zhǔn)差(x±SD)表示。治療前后比較采用配對(duì)t檢驗(yàn),所有統(tǒng)計(jì)數(shù)據(jù)以P0.05作為差異有顯著性差異的界限。 結(jié)果 經(jīng)AutoCPAP治療后患者自覺(jué)白天嗜睡癥狀減輕,夜間覺(jué)醒次數(shù)減少,情緒較前好轉(zhuǎn)。患者炎癥因子IL-6和TNF-a水平及子癇前期臨床指標(biāo)血壓和尿蛋白定量較治療前顯著降低(P0.05)。 結(jié)論 1、經(jīng)AutoCPAP治療1周后炎癥因子及子癇前期臨床指標(biāo)血壓和蛋白尿明顯降低,進(jìn)一步證實(shí)SAHS可能是導(dǎo)致子癇前期發(fā)生和發(fā)展的一個(gè)危險(xiǎn)因素。 2、對(duì)于存在SAHS的子癇前期孕婦積極給予AutoCPAP治療可通過(guò)減輕夜間呼吸暫停指數(shù)及低氧血癥來(lái)降低炎癥因子水平進(jìn)一步減輕子癇前期的臨床癥狀。
[Abstract]:background
With the deepening of sleep research, people not only understand the importance of sleep to human beings, but also gradually understand the significant impact of abnormal sleep on humans. 1 / 3 of human life are spent in sleep. In this 1 / 3 night, many sleep disorders such as dreaming, sleepwalking, insomnia and other sleep disorders. Although it has long been the attention of the medical staff, people have not given attention to it, and people know little about the effects of sleep on other diseases. Live the life of drug cans; it is not known that these accidental deaths or unexplained common diseases are likely to be associated with a common phenomenon in sleep, snoring and apnea.
With the further awareness of sleep and the development of sensing recording technology, sleep breathing disorders (Sleep Disorder Breathion, SDB) including simple snoring, obesity hypopnea syndrome, and sleep apnea hypopnea have been paid attention to and studied in the world as a disease in 1970s. Syndrome, upper airway resistance syndrome, and sleep apnea hypopnea syndrome (Sleep Apnea Hypopnea Syndrom, SAHS) are divided into obstructive sleep apnea hypopnea syndrome (Obstructive Sleep Apnea Hypopnea Syndrom, OSAHS), and central sleep apnea hypopnea syndrome. S), mixed sleep apnea hypopnea syndrome (Mixed Sleep Apnea Hypopnea Syndrom, MSAHS). The research of SAHS in China is from nowhere, from local areas to the whole country. It has gone through the history of nearly 20 years. The initial stage is some pioneering and exploratory work. The real development is a matter of recent years, with the increase of the number of sleep test rooms. In addition, the number of patients diagnosed and treated has increased correspondingly, the diagnosis and treatment technology has been continuously improved, and the research work in the field of SAHS related disciplines has been carried out, including basic and clinical research, epidemiological investigation and so on. At present, SAHS is an independent risk factor for hypertension. Sleep apnea hypopnea syndrome is mainly manifested as sleep. Snoring, accompanied by apnea and superficial breathing, recurring hypoxemia, hypercapnia and disorder of sleep structure at night, resulting in daytime sleepiness and reduced work efficiency, often accompanied by cardiovascular and cerebrovascular diseases, which seriously affect the quality of life and life of the patients. The study found that repeated anoxia and reperfusion at night in SAHS patients lead to blood. Inflammatory factors (IL-6, TNF-a, etc.) in Qing Dynasty increased significantly, and further caused hypertension and other diseases.
Pregnancy induced hypertension is a disease characterized by hypertension as the main clinical manifestation. The incidence of pregnancy is 10.5%. Preeclampsia is a more serious stage for the diagnosis of hypertensive disorders in pregnancy. It is the main cause of the incidence and mortality of pregnant and parturients and perinatal infants. Extreme prevention and intervention are the problems that the medical workers have been exploring. The etiology and pathogenesis of preeclampsia have not been fully elucidated. Although the theory of placental ischemia, the theory of vascular endothelial injury, the theory of immunity, and the theory of heredity are established, the majority of scholars have found that the serum of preeclampsia patients has been found. Inflammatory factors (IL-6, TNF-a) were significantly higher than those of normal pregnancy and were significantly correlated with the severity of preeclampsia. Williams and other studies found that the levels of TNF-a and its receptors in the peripheral blood and amniotic fluid were significantly increased before the onset of clinical symptoms, but the reasons for the increase of inflammatory factors were not yet clear.
Both IL-6 and TNF-a are the cytokines that have been found in more than 10 years. They all have extensive biological activity. They are maintained at a low level in normal pregnancy, regulate the normal growth and function of placenta tissue, participate in the maintenance of normal pregnancy, promote the proliferation and invasiveness of trophoblast cells, increase the blood supply of the uterus and promote the birth of the fetus. The growth and regulation of the immune regulation of.TNF-a and IL-6 between the mother fetus can lead to the occurrence of pathological damage in human body, such as promoting endothelial cells adhering to leukocytes, stimulating endothelial cells to secrete inflammatory mediators, activating the coagulation system, inhibiting fibrinolysis, increasing inflammatory exudation and producing oxygen free radicals, promoting the expression of cell adhesion molecules, and so on. One step leads to vasospasm and increased blood pressure, which affects the blood vessels of the kidneys and leads to proteinuria.
In recent years, many foreign mathematicians have found that SAHS has a significant correlation with preeclampsia, intrauterine fetal growth restriction, preterm birth and so on, and the blood pressure of preeclampsia patients can be significantly reduced and the normal weight fetus is produced by nCPAP treatment for pregnant women with SAHS.
We found that there are many overlapping factors in SAHS and preeclampsia, such as elevated levels of inflammatory factors and oxidative stress products, upper airway stenosis, abdominal obesity and other factors that reduce thoracic activity, endocrine changes and so on. In addition, clinical manifestations include hypertension, nocturnal segment sleep, daytime sleepiness and so on. On the basis of the study and the internationally recognized SAHS diagnostic means, polysomnography, we conducted polysomnography to assess the presence of SAHS in selected patients, and a preliminary study of the correlation between SAHS and preeclampsia and the role of inflammatory factors in the possible pathogenesis of the preeclampsia from the level of inflammatory factors and the presence of SA. One of the most effective methods for the treatment of SAHS in HS is sustained airway positive airway pressure (PVV), and the therapeutic effect is observed to further confirm the correlation between SAHS and preeclampsia.
The first chapter is a preliminary observation of the level of inflammatory factors and the correlation between SAHS and preeclampsia.
objective
The correlation between SAHS and preeclampsia was preliminarily observed and detected by detecting the levels of inflammatory factors in serum.
Method
1, cases and groups selected from July 2008 to June 2009 in the severe pregnant and lying in the hospital for the treatment of hospital delivery and hospitalized childbirth in accordance with the standards of pre eclampsia pregnant women and the same period of age, no significant difference in pregnancy age, the whole night of Polysomnogram, PSG, including 25 cases in the normal pregnancy group, In preeclampsia, there were no SAHS groups in 43 cases, preeclampsia and 27 cases in group SAHS. All of the above pregnant women were single pregnancy and had no previous hypertension, heart disease, kidney disease, diabetes and chronic lung disease, which could cause hypoxia.
2, sleep monitoring performed at least 7h polysomnography for all pregnant women. The monitoring contents included EEG, eye electricity, mandibular electromyography, electrocardiogram, mouth and nose airflow, snoring, body position, thoracic and abdominal movement and blood oxygen saturation. The data of polysomnography monitoring (PSG) were analyzed by computer automatic analysis and manual correction, reference to the Chinese Medical Association. The guidelines for the diagnosis and treatment of obstructive sleep apnea hypopnea syndrome (Draft) > adult SAHS diagnostic criteria, in which AHI is the main criterion and LSaO2 is used as a reference to make a diagnosis of the existence of SAHS and its severity.
3, the blood pressure was measured at the end of 10 minutes after the end of the sleep monitoring. The vertical mercury sphygmomanometer (Shanghai medical equipment factory) was used to measure blood pressure. The mean arterial pressure (Mean Arterial Pressure, MAP), MAP= diastolic pressure +1 / 3 (systolic pressure diastolic pressure) were taken for convenient comparison.
4,24 hours urine protein quantitation was collected from 7Am to 7Am 24 hours after the next day, and 24 hours urine protein was measured by Coomassie brilliant blue G25O4 method.
5, serum IL-6 and TNF-a were tested for 10 minutes in the morning after the second day of sleep monitoring and 10 minutes of venous blood collection, placed in the refrigerator at 4 centigrade to be separated, 3000r / min centrifuged 10min, separated from the EP tube and stored in the EP tube. The serum TNF-a and IL-6 levels were detected by enzyme linked immunosorbent assay (Enzyme-Linked Immunosorbnent) Y (ELISA), the kit is provided by Wuhan doctorate company, and the testing method is strictly operated according to the instructions.
6, statistical analysis was carried out with statistical software SPSS13.0 for statistical processing and analysis. The test data used the mean number addition and subtraction standard deviation (x + SD). The group was compared with One-Way ANOVA, the two groups were compared with LSD test, and the correlation analysis adopted all the statistical data of Pearson. as a significant difference between P0.05.
Result
1, the age between the general data groups (27.5 + 6 vs 29 + 5.3 vs 29.2 + 5, P0.05), the gestational age (31.1 + 4.9 vs 31 + 4 vs 30.6 + 4.6, P0.05) had no significant difference, and was comparable.
2, statistical analysis of clinical and laboratory indexes between groups
Three groups of body weight index (BMI), mean arterial pressure (MAP), 24h urine protein quantitative, sleep apnea hypopnea index (AHI), minimum oxygen saturation (LSaO2), IL-6 and TNF-a levels were significantly different (P0.01). However, there was no significant difference between the non SAHS group and the preeclampsia and SAHS BMI (P=0.083) in preeclampsia. There was no group in normal pregnancy and preeclampsia. There was no significant difference between AHI and LSaO2 (P=0.797,0.862).
The two important clinical indicators of preeclampsia, blood pressure and 24h urine protein quantitation were significantly correlated with the severity of SAHS (P0.01); the correlation coefficient of IL-6 and TNF-a was greater, IL-6 and TNF-a were also associated with AHI and LSaO2. Meanwhile, blood pressure and urinary protein were found to be associated with BMI, but the correlation was weak.
conclusion
1, the number of nocturnal sleep apnea hypopnea in preeclampsia pregnant women is significantly higher than that of normal pregnant women, indicating a relative increase in the incidence of SAHS in preeclampsia pregnant women.
2, inflammatory factors (IL-6 and TNF-a) may play an important role in the pathogenesis of preeclampsia complicated with SAHS.
3, SAHS may be a risk factor for the occurrence and development of preeclampsia.
The second chapter: AutoCPAP in the treatment of preeclampsia with SAHS.
objective
The effect of AutoCPAP treatment on preeclampsia pregnant women with SAHS was observed, and the correlation between SAHS and pre eclampsia was further confirmed.
Method
1, 27 cases of pregnant women with SAHS confirmed by polysomnography were selected, and their age, gestational age and BMI were re counted.
2, AutoCPAP treatment was given to pregnant women who were confirmed by polysomnography to meet the SAHS diagnostic criteria for further explanation of the AutoCPAP treatment, and signed the informed consent to give at least 4 hours of treatment a day to explain the use of the ventilator in detail to the patient, the problem of wearing the mask and the possible questions in the process of use. The problem and solution were given after the patient was fully understood. Because most patients were not very adaptable to the initial use, they were given a delay of 30 minutes and given a humidification to adapt the patient to acceptance. The pressure range of the ventilator was fixed at 4 to 20cmH2O..
3, the blood pressure was measured at the end of 10 minutes after the end of the sleep monitoring. The vertical mercury sphygmomanometer (Shanghai medical equipment factory) was used to measure blood pressure. The mean arterial pressure (Mean Arterial Pressure, MAP), MAP= diastolic pressure +1 / 3 (systolic pressure diastolic pressure) were taken for convenient comparison.
4,24 hours urine protein quantitation was collected from 7Am to 7Am 24 hours after the next day, and 24 hours urine protein was measured by Coomassie brilliant blue G25O4 method.
5, serum IL-6 and TNF-a were detected by AutoCPAP in the early morning of seventh. After 10 minutes of waking up in the venous blood collection 6ml, the serum was separated in the refrigerator at 4 centigrade, 3000r / min was centrifuged 10min, separated in the EP tube and stored at -80. The serum TNF-a and IL-6 levels were detected by enzyme linked immunosorbent assay, the kit was from Wuhan doctor The German company provides the testing methods strictly according to the instructions.
6, statistical analysis was carried out by statistical software SPSS13.0 for statistical processing and analysis. The data of experimental data were expressed by mean plus minus standard deviation (x + SD).
【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】：2010
【分類(lèi)號(hào)】：R766

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