阻塞性睡眠呼吸暫停低通氣綜合征中醫(yī)證候與PM監(jiān)測指標(biāo)相關(guān)性研究
發(fā)布時間：2018-08-07 20:15
【摘要】：研究目的：基于臟腑辨證理論研究阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)的中醫(yī)證候分布特點,并分析中醫(yī)證候與體重指數(shù)(BMI)、呼吸暫停低通氣指數(shù)(AHI)、最低血氧飽和度(LSaO2)、Epworth嗜睡量表評分(ESS評分)之間的相關(guān)性,試圖為OSAHS的中醫(yī)辨證尋求更加客觀的參考指標(biāo),為OSAHS的臨床個體化治療方案的選擇提供依據(jù),以進(jìn)一步提高臨床療效及患者的依從性。研究方法：選取2013年12月至2015年12月在中國中醫(yī)科學(xué)院望京醫(yī)院睡眠呼吸障礙專病門診就診的打鼾患者,使用便攜式睡眠呼吸監(jiān)測儀(PM)對其進(jìn)行睡眠呼吸監(jiān)測,納入符合OSAHS診斷標(biāo)準(zhǔn)的病例240例。測量并記錄患者的身高、體重、頸圍、睡眠監(jiān)測結(jié)果,計算體重指數(shù),填寫鼾眠患者基本信息表和Epworth嗜睡量表,由兩位主治以上醫(yī)師收集患者中醫(yī)四診資料(包括癥狀、舌象、脈象、面色等),并依據(jù)中醫(yī)臟腑辨證分型標(biāo)準(zhǔn)確定最終中醫(yī)證候。將收集到的資料及信息輸入計算機,使用EpiData建立數(shù)據(jù)庫,并生成Excel文件,所有數(shù)據(jù)均應(yīng)用統(tǒng)計軟件SPSS 20.0進(jìn)行統(tǒng)計分析。研究結(jié)果：1、240例OSAHS患者中,男性182例(占75.8%),女性58例(24.2%),男性發(fā)病率明顯高于女性；2、240例患者的平均年齡為(52.4±14)歲,其中年齡在45-60歲的患者108例(占45%),發(fā)病群體以中年人居多；3、240例患者的平均體重指數(shù)(29.13±4.1)Kg/m2,其中肥胖者(BMI≥128)共計142例,占59.2%,半數(shù)以上OSAHS患者合并肥胖；4、中醫(yī)證候分布比例為：痰熱壅肺證74例(占30.8%),寒濕困脾證70例(占29.2%),肺脾氣虛證52例(占21.7%),心血瘀阻證22例(占,9.2%)腎陽虧虛證20例(占,8.3%),肝郁氣滯證2例(占0.8%)；OSAHS患者并非都是單一證候,混合證候占29.2%,常見的證候相兼組合為：寒濕困脾證+肺脾氣虛證、寒濕困脾證+心血瘀阻證、肺脾氣虛證+心血瘀阻證；5、四診資料分布：出現(xiàn)頻率在40%以上的癥狀依次為：打鼾、嗜睡、口渴、健忘、疲乏無力、胸脘滿悶、肢體困重、自汗、口苦,主要舌質(zhì)為淡白舌(占63.3%),主要舌苔為白膩苔(40%)、黃膩苔(31.2%)、薄白苔(23.3%),主要脈象為滑脈、細(xì)脈、數(shù)脈、弦脈；6、在240例OSAHS患者中合并高血壓者最多,共156例,占65%；其次為高脂血癥70例(占29.2%)、冠心病59例(占24.6%)、糖尿病48例(占20%)、腦血管病26例(占10.8%)、心律失常17例(7.1%)。其中高血壓多見于寒濕困脾證(47例)、痰熱壅肺證(45例)、肺脾氣虛證(27例),冠心病多見于心血瘀阻證(17例)、寒濕困脾證(14例),高脂血癥在寒濕困脾證中最多(33例),其次為痰熱壅肺證(17例)；糖尿病在痰熱壅肺證中最多(16例),其次為寒濕困脾證(10例),腦血管病多發(fā)生于。腎陽虧虛證。7、不同中醫(yī)證候間AHI、最低血氧飽和度的差異無統(tǒng)計學(xué)意義(P0.05)；痰熱壅肺證的BMI水平高于肺脾氣虛證、心血瘀阻證及腎陽虧虛證(P＜0.05),腎陽虧虛證的頸圍低于痰熱壅肺證、寒濕困脾證、肺脾氣虛證及心血瘀阻證(P0.05),痰熱壅肺證的最長暫停時間高于寒濕困脾證、心血瘀阻證及腎陽虧虛證(P0.05),痰熱壅肺證的平均暫停時間高于肺脾氣虛證及腎陽虧虛證(P＜0.05)：8、在OSAHS中醫(yī)證候與PM監(jiān)測指標(biāo)及BMI、ESS評分的相關(guān)性研究中,采用Logistic回歸分析,歸納出回歸方程如下：痰熱壅肺證：Logit (p)=0.728X1+1.88X4-5.198寒濕困脾證：Logit(p)=1.82X1+0.528X2-3.39肺脾氣虛證：Logit (p)=0.799X2-0.846X3-1.474心血瘀阻證：Logit (p)=1.65X2-3.344X3+2.077X4-4.276腎陽虧虛證：Logit (p)=1.65X2-2.311X3-2.69其中,X1、X2、X3、X4分別代表BMI、AHI、LSaO2、ESS評分研究結(jié)論：OSAHS中的中醫(yī)證候分布特點為：痰熱壅肺證寒濕困脾證肺脾氣虛證心血瘀阻證腎陽虧虛證肝郁氣滯證,其發(fā)病與五臟功能失調(diào)相關(guān)。OSAHS 一般存在多種合并癥,并且合并癥與中醫(yī)證候間有一定的關(guān)系,如高血壓多見于痰熱壅肺證、寒濕困脾證,高脂血癥多見于寒濕困脾證,冠心病多見于心血瘀阻證,腦血管病多見于腎陽虧虛證。痰熱壅肺證的體重指數(shù)、嗜睡程度、暫停時間均明顯高于其他證候,說明痰熱是OSAHS的重要病理因素。不同證候類型與PM監(jiān)測指標(biāo)及BMI、ESS評分的相關(guān)性不同,痰熱壅肺證主要與BMI、ESS評分相關(guān),寒濕困脾證主要與BMI相關(guān),肺脾氣虛證主要與AHI、LSaO2相關(guān),心血瘀阻證主要與LSaO2相關(guān),腎陽虧虛證主要與AHI、LSaO2相關(guān),提示對于痰熱壅肺證及寒濕困脾證的患者治療方面可以首先考慮減肥、控制體重為主,對于肺脾氣虛證、心血瘀阻證及腎陽虧虛證患者應(yīng)首先考慮以持續(xù)氣道正壓通氣(CPAP)治療為主,以降低呼吸暫停低通氣指數(shù)、改善缺氧狀態(tài)。
[Abstract]:Objective: To study the characteristics of TCM Syndrome Distribution in obstructive sleep apnea hypopnea syndrome (OSAHS) based on viscera syndrome differentiation theory, and analyze the correlation between TCM syndrome and body mass index (BMI), apnea hypopnea index (AHI), minimum oxygen saturation (LSaO2), Epworth somnolence scale (ESS score), and try to be a OSAHS The TCM syndrome differentiation seeks more objective index to provide basis for the selection of clinical individualized treatment schemes for OSAHS, and to further improve the clinical efficacy and compliance of the patients. A portable sleep breathing monitor (PM) was used to monitor 240 cases of the patients' height, weight, neck circumference, sleep monitoring, body mass index, the basic information table of snoring patients and the Epworth somnolence scale, which were collected by two doctors and above. The data of four medical diagnosis (including symptoms, tongue image, pulse image, face color, etc.), and determining the final TCM syndrome according to the syndrome differentiation and classification standard of traditional Chinese medicine. The collected data and information are input to the computer, the database is set up by EpiData, and the Excel file is generated. All the data are statistically analyzed by the statistical software SPSS 20. The results of the study are 1240 cases of O Among the patients with SAHS, 182 were male (75.8%) and 58 women (24.2%). The average age of male was significantly higher than that of women; the average age of 2240 patients was (52.4 + 14) years, of which 108 (45%) were in 45-60 years of age (45%), the average body mass index of 3240 patients (29.13 + 4.1), and the obese (BMI > 58). A total of 142 cases, accounting for 59.2%, more than half of OSAHS patients merged with obesity; 4, the proportion of TCM syndrome distribution was 74 cases of phlegm heat syndrome (30.8%), 70 cases of cold dampness and spleen syndrome (29.2%), 52 cases of spleen qi deficiency syndrome (21.7%), 22 cases of heart blood stasis syndrome (occupied, 9.2%) kidney yang deficiency syndrome 20 cases (occupied, 8.3%), and stagnation of liver qi stagnation syndrome in 22 cases (accounting for 29.2%); the patients of OSAHS were not all It was a single syndrome, mixed syndrome accounted for 29.2%, common syndromes and combination were: cold dampness and spleen syndrome + spleen qi deficiency syndrome, cold dampness and spleen syndrome + heart blood stasis syndrome, lung spleen qi deficiency syndrome + heart blood stasis syndrome; 5, four diagnosis data distribution: the frequency of symptoms above 40% were: snoring, drowsiness, thirst, forgetfulness, fatigue and weakness, chest cavity full stuffy, limb sleepiness Heavy, self perspiration, bitter taste, the main tongue is pale tongue (63.3%), the main tongue fur is white and greasy fur (40%), yellow greasy fur (31.2%), thin white moss (23.3%), the main pulse is slippery pulse, vein, pulse, chord pulse; 6, 240 cases of OSAHS patients with hypertension, a total of 156 cases, accounting for 65%, followed by hyperlipidemia in 29.2% (29.2%), coronary heart disease 59 cases (24.6%), diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus, and diabetes mellitus, diabetes mellitus (29.2%), diabetes mellitus (24.6%), diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus (31.2%), and diabetes mellitus (24.6%), and diabetes mellitus There were 48 cases (20%), 26 cases of cerebrovascular disease (10.8%) and 17 cases of arrhythmia (7.1%). Among them, hypertension was mostly found in cold dampness and spleen syndrome (47 cases), phlegm heat syndrome (45 cases), lung spleen qi deficiency syndrome (27 cases), coronary heart disease in 17 cases (17 cases), cold dampness and spleen syndrome (14 cases), hyperlipidemia in cold dampness and spleen syndrome (33 cases), and second was sputum heat obstructing syndrome (1). 7 cases (7 cases), the most (16 cases) in the syndrome of phlegm heat obstructing the lung, followed by the syndrome of cold dampness and spleen (10 cases), cerebrovascular disease occurred mostly in the deficiency of kidney yang deficiency syndrome (AHI), the difference of the lowest blood oxygen saturation between different TCM syndromes was not statistically significant (P0.05); the level of phlegm heat obstructing lung syndrome was higher than that of lung spleen qi deficiency syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome (P < 0.). 05) the neck circumference of kidney yang deficiency syndrome is lower than that of phlegm heat obstructing the lung syndrome, cold dampness and spleen syndrome, lung spleen qi deficiency syndrome and heart blood stasis syndrome (P0.05), the longest suspension time of phlegm heat obstructing lung syndrome is higher than that of cold dampness and spleen syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome (P0.05), the average temporary stopping time of phlegm heat obstructing lung syndrome is higher than that of lung qi deficiency syndrome and kidney yang deficiency syndrome (P < 0.05):8. OSAHS TCM syndrome and PM monitoring indexes and the correlation of BMI and ESS scores were analyzed by Logistic regression analysis, and the regression equation was summarized as follows: phlegm heat obstructing lung syndrome: Logit (P) =0.728X1+1.88X4-5.198 cold dampness and spleen syndrome: Logit (P) =1.82X1+0.528X2-3.39 lung qi deficiency syndrome: Logit =1.65X2-3.344X3+2.077X4-4.276 kidney yang deficiency syndrome: Logit (P) =1.65X2-2.311X3-2.69, X1, X2, X3, X4 represent BMI, AHI, LSaO2, and ESS score study conclusion: the characteristics of TCM Syndrome Distribution: phlegm heat obstructing the lung syndrome, cold dampness syndrome, spleen syndrome, spleen qi deficiency syndrome, kidney yang deficiency syndrome, kidney yang deficiency syndrome liver qi stagnation syndrome, its disease and five zang organs work Disorders related.OSAHS generally have a variety of complications, and there is a certain relationship between complications and TCM syndromes, such as hypertension often seen in phlegm heat syndrome, cold dampness and spleen syndrome, hyperlipidemia often seen in cold dampness and spleen syndrome, coronary heart disease often seen in heart blood stasis syndrome, cerebrovascular disease is mostly found in kidney yang deficiency syndrome. The degree of sleep and the time of pause were obviously higher than other syndromes, indicating that phlegm fever is an important pathological factor of OSAHS. The correlation of different syndromes with PM monitoring index and BMI, ESS score is different. The syndrome of phlegm heat accumulation is mainly related to BMI, ESS score, and the syndrome of spleen and spleen is mainly related to BMI, and the deficiency of spleen and spleen is mainly related to AHI, LSaO2 and blood stasis syndrome. To be related to LSaO2, the deficiency syndrome of Kidney Yang is mainly related to AHI and LSaO2, which suggests that the treatment of phlegm heat obstructing lung syndrome and cold dampness and dampness of spleen syndrome can first consider weight loss and control weight, and the patients with Qi deficiency syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome should be first considered with continuous positive airway pressure ventilation (CPAP) treatment, in order to reduce the deficiency syndrome. Apnea hypopnea index improves anoxia.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R276.1
本文編號：2171227
[Abstract]:Objective: To study the characteristics of TCM Syndrome Distribution in obstructive sleep apnea hypopnea syndrome (OSAHS) based on viscera syndrome differentiation theory, and analyze the correlation between TCM syndrome and body mass index (BMI), apnea hypopnea index (AHI), minimum oxygen saturation (LSaO2), Epworth somnolence scale (ESS score), and try to be a OSAHS The TCM syndrome differentiation seeks more objective index to provide basis for the selection of clinical individualized treatment schemes for OSAHS, and to further improve the clinical efficacy and compliance of the patients. A portable sleep breathing monitor (PM) was used to monitor 240 cases of the patients' height, weight, neck circumference, sleep monitoring, body mass index, the basic information table of snoring patients and the Epworth somnolence scale, which were collected by two doctors and above. The data of four medical diagnosis (including symptoms, tongue image, pulse image, face color, etc.), and determining the final TCM syndrome according to the syndrome differentiation and classification standard of traditional Chinese medicine. The collected data and information are input to the computer, the database is set up by EpiData, and the Excel file is generated. All the data are statistically analyzed by the statistical software SPSS 20. The results of the study are 1240 cases of O Among the patients with SAHS, 182 were male (75.8%) and 58 women (24.2%). The average age of male was significantly higher than that of women; the average age of 2240 patients was (52.4 + 14) years, of which 108 (45%) were in 45-60 years of age (45%), the average body mass index of 3240 patients (29.13 + 4.1), and the obese (BMI > 58). A total of 142 cases, accounting for 59.2%, more than half of OSAHS patients merged with obesity; 4, the proportion of TCM syndrome distribution was 74 cases of phlegm heat syndrome (30.8%), 70 cases of cold dampness and spleen syndrome (29.2%), 52 cases of spleen qi deficiency syndrome (21.7%), 22 cases of heart blood stasis syndrome (occupied, 9.2%) kidney yang deficiency syndrome 20 cases (occupied, 8.3%), and stagnation of liver qi stagnation syndrome in 22 cases (accounting for 29.2%); the patients of OSAHS were not all It was a single syndrome, mixed syndrome accounted for 29.2%, common syndromes and combination were: cold dampness and spleen syndrome + spleen qi deficiency syndrome, cold dampness and spleen syndrome + heart blood stasis syndrome, lung spleen qi deficiency syndrome + heart blood stasis syndrome; 5, four diagnosis data distribution: the frequency of symptoms above 40% were: snoring, drowsiness, thirst, forgetfulness, fatigue and weakness, chest cavity full stuffy, limb sleepiness Heavy, self perspiration, bitter taste, the main tongue is pale tongue (63.3%), the main tongue fur is white and greasy fur (40%), yellow greasy fur (31.2%), thin white moss (23.3%), the main pulse is slippery pulse, vein, pulse, chord pulse; 6, 240 cases of OSAHS patients with hypertension, a total of 156 cases, accounting for 65%, followed by hyperlipidemia in 29.2% (29.2%), coronary heart disease 59 cases (24.6%), diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus, and diabetes mellitus, diabetes mellitus (29.2%), diabetes mellitus (24.6%), diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus (31.2%), and diabetes mellitus (24.6%), and diabetes mellitus There were 48 cases (20%), 26 cases of cerebrovascular disease (10.8%) and 17 cases of arrhythmia (7.1%). Among them, hypertension was mostly found in cold dampness and spleen syndrome (47 cases), phlegm heat syndrome (45 cases), lung spleen qi deficiency syndrome (27 cases), coronary heart disease in 17 cases (17 cases), cold dampness and spleen syndrome (14 cases), hyperlipidemia in cold dampness and spleen syndrome (33 cases), and second was sputum heat obstructing syndrome (1). 7 cases (7 cases), the most (16 cases) in the syndrome of phlegm heat obstructing the lung, followed by the syndrome of cold dampness and spleen (10 cases), cerebrovascular disease occurred mostly in the deficiency of kidney yang deficiency syndrome (AHI), the difference of the lowest blood oxygen saturation between different TCM syndromes was not statistically significant (P0.05); the level of phlegm heat obstructing lung syndrome was higher than that of lung spleen qi deficiency syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome (P < 0.). 05) the neck circumference of kidney yang deficiency syndrome is lower than that of phlegm heat obstructing the lung syndrome, cold dampness and spleen syndrome, lung spleen qi deficiency syndrome and heart blood stasis syndrome (P0.05), the longest suspension time of phlegm heat obstructing lung syndrome is higher than that of cold dampness and spleen syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome (P0.05), the average temporary stopping time of phlegm heat obstructing lung syndrome is higher than that of lung qi deficiency syndrome and kidney yang deficiency syndrome (P < 0.05):8. OSAHS TCM syndrome and PM monitoring indexes and the correlation of BMI and ESS scores were analyzed by Logistic regression analysis, and the regression equation was summarized as follows: phlegm heat obstructing lung syndrome: Logit (P) =0.728X1+1.88X4-5.198 cold dampness and spleen syndrome: Logit (P) =1.82X1+0.528X2-3.39 lung qi deficiency syndrome: Logit =1.65X2-3.344X3+2.077X4-4.276 kidney yang deficiency syndrome: Logit (P) =1.65X2-2.311X3-2.69, X1, X2, X3, X4 represent BMI, AHI, LSaO2, and ESS score study conclusion: the characteristics of TCM Syndrome Distribution: phlegm heat obstructing the lung syndrome, cold dampness syndrome, spleen syndrome, spleen qi deficiency syndrome, kidney yang deficiency syndrome, kidney yang deficiency syndrome liver qi stagnation syndrome, its disease and five zang organs work Disorders related.OSAHS generally have a variety of complications, and there is a certain relationship between complications and TCM syndromes, such as hypertension often seen in phlegm heat syndrome, cold dampness and spleen syndrome, hyperlipidemia often seen in cold dampness and spleen syndrome, coronary heart disease often seen in heart blood stasis syndrome, cerebrovascular disease is mostly found in kidney yang deficiency syndrome. The degree of sleep and the time of pause were obviously higher than other syndromes, indicating that phlegm fever is an important pathological factor of OSAHS. The correlation of different syndromes with PM monitoring index and BMI, ESS score is different. The syndrome of phlegm heat accumulation is mainly related to BMI, ESS score, and the syndrome of spleen and spleen is mainly related to BMI, and the deficiency of spleen and spleen is mainly related to AHI, LSaO2 and blood stasis syndrome. To be related to LSaO2, the deficiency syndrome of Kidney Yang is mainly related to AHI and LSaO2, which suggests that the treatment of phlegm heat obstructing lung syndrome and cold dampness and dampness of spleen syndrome can first consider weight loss and control weight, and the patients with Qi deficiency syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome should be first considered with continuous positive airway pressure ventilation (CPAP) treatment, in order to reduce the deficiency syndrome. Apnea hypopnea index improves anoxia.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R276.1
【相似文獻(xiàn)】
相關(guān)期刊論文 前3條
1 王常松;吳同玉;陳學(xué)習(xí);閔莉;;寒濕困脾證動物模型的建立和評價[J];上海中醫(yī)藥大學(xué)學(xué)報;2011年05期
2 吉兆奕;徐詠梅;王笑民;;癌癥相關(guān)性疲乏患者疲勞特征與中醫(yī)辨證的臨床研究[J];癌癥進(jìn)展;2011年01期
3 ;[J];;年期
相關(guān)重要報紙文章 前1條
1 遼寧中醫(yī)藥大學(xué)附屬醫(yī)院 張明雪;寒濕困脾證與濕熱蘊脾證鑒別[N];中國中醫(yī)藥報;2012年
相關(guān)碩士學(xué)位論文 前1條
1 靳艷果;阻塞性睡眠呼吸暫停低通氣綜合征中醫(yī)證候與PM監(jiān)測指標(biāo)相關(guān)性研究[D];中國中醫(yī)科學(xué)院;2016年
，本文編號：2171227
本文鏈接：http://sikaile.net/zhongyixuelunwen/2171227.html
最近更新
教材專著
