同期多平面聯(lián)合手術(shù)治療阻塞性睡眠呼吸暫停低通氣綜合征及手術(shù)前后瘦素濃度變化的研究
發(fā)布時間：2019-07-09 06:12
【摘要】：阻塞性睡眠呼吸暫停低通氣綜合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)是臨床上最常見的睡眠呼吸障礙疾病之一。該病發(fā)病率較高,美國的流行病調(diào)查發(fā)現(xiàn)50歲的人群中2%的女性及4%的男性有呼吸暫停的癥狀。隨著社會生活節(jié)奏的加快,該病的發(fā)病率也明顯增加,而且發(fā)病年齡逐漸年輕化。OSAHS患者不僅睡眠打鼾、呼吸暫停,同時白天嗜睡、精神不振,長期的患有該病還會導(dǎo)致高血壓、心臟病、糖尿病、腦血管疾病等,嚴重危害患者的身體健康。 盡管OSAHS的病理生理機制尚不完全清楚,但是睡眠中反復(fù)出現(xiàn)的部分或完全上氣道塌陷可導(dǎo)致OSAHS是確定的。發(fā)生在任何平面的上氣道塌陷,包括鼻腔,咽(鼻咽,口咽和喉咽),喉腔都可導(dǎo)致OSAHS的發(fā)生。上氣道塌陷可能是單個平面也可能是多個平面。OSAHS外科治療的目的是擴大氣道和防止氣道塌陷,手術(shù)的關(guān)鍵是需要確定所有的阻塞平面并解除相應(yīng)狹窄平面。當(dāng)然OSAHS手術(shù)的成功不僅僅與阻塞部位及阻塞程度有關(guān),還與患者自身的情況相關(guān)。對于經(jīng)過選擇的OSAHS患者,手術(shù)治療效果顯著,長期療效和持續(xù)氣道正壓通氣(Continuous positive airway pressure, CPAP)的效果相當(dāng)。 OSAHS手術(shù)治療的方式發(fā)展迅速,由最初的懸雍垂腭咽成型術(shù),發(fā)展到舌骨懸吊、頦前、舌根部分切除等,手術(shù)復(fù)雜程度也大大增加,由原先的單一腭咽平面手術(shù)發(fā)展到多平面手術(shù)。很多OSAHS患者往往存在多平面阻塞,特別是重度OSAHS患者。同期手術(shù)一方面可以解除所有的狹窄平面,手術(shù)療效確切,另一方面可以避免分次手術(shù)給患者帶來的痛苦及經(jīng)濟負擔(dān)。 肥胖特別是中心型肥胖是公認導(dǎo)致OSAHS的最重要的原因之一,50%以上的OSAHS患者肥胖,而肥胖患者中約有10%～20%患有OSAHS。OSAHS患者頸圍較大,咽旁間隙脂肪沉積較多,氣道狹窄,氣道壁的順應(yīng)性大,氣道容易塌陷。OSAHS患者也常伴有內(nèi)臟脂肪的堆積,這將導(dǎo)致肺容積減少,造成吸氣時下呼吸道對主氣管和上氣道的縱向牽拉作用減弱,使咽壁順應(yīng)性增大。OSAHS患者較正常人的頸圍、腰圍及腰臀比要大,也表明更多的脂肪沉積,而且更容易沉積在頸部及腹部。 瘦素(leptin)是一種由肥胖基因(ob)編碼的激素,主要由白色脂肪細胞分泌。瘦素的作用包括抑制食欲、減少能量攝取、促進脂肪分解和抑制脂肪合成、調(diào)節(jié)糖代謝的平衡等。許多研究均表明OSAHS患者血清瘦素濃度比正常者高,而且其水平隨OSAHS的嚴重程度增加,和呼吸暫停低通氣指數(shù)(Apnea hypopnea index,AHI)呈正相關(guān)。同時瘦素濃度和體重指數(shù)呈正相關(guān),并可反映體內(nèi)脂肪的含量。在OSAHS發(fā)病機制中,瘦素起到重要作用,絕大多數(shù)OSAHS患者同時存在血清瘦素濃度的增高和瘦素抵抗,兩者往往互相影響,導(dǎo)致惡性循環(huán)。OSAHS患者血清瘦素水平升高的原因很多,可能因為上氣道炎癥、交感神經(jīng)活性增加、瘦素的分泌節(jié)律打斷,另外OSAHS患者血清瘦素可防止呼吸抑制的發(fā)生,是一種保護機制。瘦素的抵抗機制不完全明了,可能的原因有患者體內(nèi)存在瘦素抗體或拮抗物、瘦素的運輸通道障礙、瘦素信號轉(zhuǎn)導(dǎo)通路缺陷、瘦素受體缺乏或受體突變不能發(fā)揮作用等。 本研究主要探討同期多平面手術(shù)治療OSAHS患者的治療方式及手術(shù)療效等。觀察OSAHS患者及OSAHS術(shù)后患者與正常人體內(nèi)血清瘦素水平的變化,以便了解OSAHS患者手術(shù)后瘦素水平變化及手術(shù)對于OSAHS患者體內(nèi)瘦素水平的影響,以期對于OSAHS的流行性調(diào)查及手術(shù)效果的評價等作出相應(yīng)指導(dǎo)。
[Abstract]:Obstructive sleep apnea-hypoventilation syndrome (OSAHS) is one of the most common sleep disordered breathing disorders in the world. The incidence of the disease is high, and the epidemiological survey in the United States found that 2% of the 50-year-old population and 4% of men had symptoms of apnea. With the rapid development of the social life rhythm, the incidence of the disease is also obviously increased, and the age of the disease is gradually younger. OSAHS patients not only sleep snoring, apnea, but also daytime sleepiness, lassitude, long-term suffering from the disease can also cause hypertension, heart disease, diabetes, cerebrovascular disease, etc., and seriously endanger the health of the patients. Although the pathophysiological mechanism of OSAHS is not completely clear, the repeated partial or complete upper airway collapse in sleep may result in OSAHS determination . The upper airway collapse in any plane, including the nasal cavity, the pharynx (nasopharynx, oropharynx, and the throat), can lead to the delivery of the OSAHS Students. The upper airway collapse may be a single plane or multiple levels The purpose of the OSAHS surgical treatment is to enlarge the airway and prevent the airway collapse, and the key to the procedure is to determine all the occlusion planes and to release the corresponding stenosis Face. Of course, the success of the OSAHS operation is not only related to the blocking position and the degree of blockage, but also with the patient's own condition Closed. The effect of significant, long-term efficacy and continuous positive airway pressure (CPAP) for selected OSAHS patients When the operation of OSAHS was developed rapidly, the operation complexity of the operation was greatly increased, and the original single oropharynx plane operation was developed to the level of multi-level after the initial suspension of the uvula, the development of the suspension of the hyoid bone, the partial removal of the tongue and the like. Surface surgery. Many OSAHS patients often have multi-plane occlusion, especially severe OSAH S patients. In the same period, all the narrow planes can be released, the operation effect is exact, and on the other hand, the pain and the pain caused by the graded operation can be avoided. Obesity, in particular, is one of the most important causes of OSAHS, and more than 50% of the OSAHS patients are obese, and about 10% to 20% of the obese patients suffer from OSAHS. OSAHS patients have a large neck circumference, more fat deposits in the parapharyngeal space, stenosis of the airway, large compliance of the airway wall, OSAHS patients are often accompanied by the accumulation of visceral fat, which will result in a reduction in the volume of the lung resulting in a reduction in the longitudinal pull of the main and upper airways in the lower respiratory tract, making the pharyngeal wall The compliance was increased. The neck circumference, waist and waist-to-hip ratio of the patients with OSAHS were higher than that of normal persons, and it also indicated that more fat was deposited and more easily deposited. The neck and the abdomen. Leptin is a hormone encoded by the obesity gene (ob), mainly from white The effects of leptin include inhibiting appetite, reducing energy uptake, promoting lipolysis, and inhibiting fat synthesis, regulation, The balance of sugar metabolism and the like. Many studies have shown that the serum leptin concentration in the OSAHS patients is higher than that of the normal, and its level increases with the severity of the OSAHS, and the Apnea hyopnea index, A The level of leptin and body mass index are positively correlated and can be reflected In the pathogenesis of OSAHS, leptin plays an important role in the pathogenesis of OSAHS. in addition, that serum leptin in the OSAHS patient can prevent the occurrence of respiratory depression, It is a protective mechanism. The resistance mechanism of leptin is not completely clear, and may be caused by the presence of leptin antibody or antagonist in the patient, the transport channel disorder of leptin, the deficiency of leptin signal transduction pathway, the lack of leptin receptor or the receptor mutation, This study mainly discusses the treatment of OSAHS patients by multi-plane operation in the same period. To investigate the changes of serum leptin level in patients with OSAHS and OSAHS in patients with OSAHS and the effect of the operation on the level of leptin in the patients with OSAHS, with a view to the epidemic investigation and surgical effect of OSAHS.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R766
本文編號：2511915
[Abstract]:Obstructive sleep apnea-hypoventilation syndrome (OSAHS) is one of the most common sleep disordered breathing disorders in the world. The incidence of the disease is high, and the epidemiological survey in the United States found that 2% of the 50-year-old population and 4% of men had symptoms of apnea. With the rapid development of the social life rhythm, the incidence of the disease is also obviously increased, and the age of the disease is gradually younger. OSAHS patients not only sleep snoring, apnea, but also daytime sleepiness, lassitude, long-term suffering from the disease can also cause hypertension, heart disease, diabetes, cerebrovascular disease, etc., and seriously endanger the health of the patients. Although the pathophysiological mechanism of OSAHS is not completely clear, the repeated partial or complete upper airway collapse in sleep may result in OSAHS determination . The upper airway collapse in any plane, including the nasal cavity, the pharynx (nasopharynx, oropharynx, and the throat), can lead to the delivery of the OSAHS Students. The upper airway collapse may be a single plane or multiple levels The purpose of the OSAHS surgical treatment is to enlarge the airway and prevent the airway collapse, and the key to the procedure is to determine all the occlusion planes and to release the corresponding stenosis Face. Of course, the success of the OSAHS operation is not only related to the blocking position and the degree of blockage, but also with the patient's own condition Closed. The effect of significant, long-term efficacy and continuous positive airway pressure (CPAP) for selected OSAHS patients When the operation of OSAHS was developed rapidly, the operation complexity of the operation was greatly increased, and the original single oropharynx plane operation was developed to the level of multi-level after the initial suspension of the uvula, the development of the suspension of the hyoid bone, the partial removal of the tongue and the like. Surface surgery. Many OSAHS patients often have multi-plane occlusion, especially severe OSAH S patients. In the same period, all the narrow planes can be released, the operation effect is exact, and on the other hand, the pain and the pain caused by the graded operation can be avoided. Obesity, in particular, is one of the most important causes of OSAHS, and more than 50% of the OSAHS patients are obese, and about 10% to 20% of the obese patients suffer from OSAHS. OSAHS patients have a large neck circumference, more fat deposits in the parapharyngeal space, stenosis of the airway, large compliance of the airway wall, OSAHS patients are often accompanied by the accumulation of visceral fat, which will result in a reduction in the volume of the lung resulting in a reduction in the longitudinal pull of the main and upper airways in the lower respiratory tract, making the pharyngeal wall The compliance was increased. The neck circumference, waist and waist-to-hip ratio of the patients with OSAHS were higher than that of normal persons, and it also indicated that more fat was deposited and more easily deposited. The neck and the abdomen. Leptin is a hormone encoded by the obesity gene (ob), mainly from white The effects of leptin include inhibiting appetite, reducing energy uptake, promoting lipolysis, and inhibiting fat synthesis, regulation, The balance of sugar metabolism and the like. Many studies have shown that the serum leptin concentration in the OSAHS patients is higher than that of the normal, and its level increases with the severity of the OSAHS, and the Apnea hyopnea index, A The level of leptin and body mass index are positively correlated and can be reflected In the pathogenesis of OSAHS, leptin plays an important role in the pathogenesis of OSAHS. in addition, that serum leptin in the OSAHS patient can prevent the occurrence of respiratory depression, It is a protective mechanism. The resistance mechanism of leptin is not completely clear, and may be caused by the presence of leptin antibody or antagonist in the patient, the transport channel disorder of leptin, the deficiency of leptin signal transduction pathway, the lack of leptin receptor or the receptor mutation, This study mainly discusses the treatment of OSAHS patients by multi-plane operation in the same period. To investigate the changes of serum leptin level in patients with OSAHS and OSAHS in patients with OSAHS and the effect of the operation on the level of leptin in the patients with OSAHS, with a view to the epidemic investigation and surgical effect of OSAHS.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R766
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