阻塞性睡眠呼吸暂停低通气综合征疾病严重程度临床评估的初步探讨
发布时间：2018-03-21 07:28
本文选题：阻塞性睡眠呼吸暂停低通气综合征obstructive 切入点：sleep 出处：《华中科技大学》2012年博士论文 论文类型：学位论文
【摘要】：第一部分 阻塞性睡眠呼吸暂停低通气综合征疾病严重程度与代谢综合征 目的：探讨不同程度阻塞性睡眠呼吸暂停低通气综合症(obstructive sleep apnea hypopnea syndrome, OSAHS)患者代谢综合征的发病率、影响因素及临床特点。 方法：采用回顾性分析,97例经整夜多导睡眠监测确诊为OSAHS患者,依AHI指数分为轻中度(5-≤AHI30)、重度(30AHI55)及极重度(AHI55)3组,询问、记录高血压、冠心病、糖尿病或糖代谢异常、高血脂或脂代谢异常病史及用药史,测量记录收缩压、舒张压、身高、体重、颈围、腰围等一般身体情况。整夜睡眠监测次日晨起时标准静脉穿刺抽取前臂肘静脉空腹血,全自动生化分析仪检测空腹血糖、血总胆固醇、甘油三脂、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等生化指标。依“2007年中国成人血脂异常防治指南”对代谢综合征进行诊断。分析比较不同程度OSAHS患者代谢综合征的发病率、在不同组别的分布特点、临床特征等。计量数据用均数±标准差(mean±sd)表示,使用spss17.0统计软件进行数据统计与分析,采用非参数独立样本t检验比较组内、组间差异性,P0.05,认为差异具有统计学意义,P0.01,认为差异具有高度统计学意义。Pearson相关性检验两组数据之间的相关性。采用多因素logistic回归分析以除外混杂因素对结果的影响。 结果：本研究OSAHS组中代谢综合征的发病率为48.5%,各组别的发病率分别为：轻中度组为33.3%,重度组为43.3%,极重度组57.1%。显示随AHI指数的增加,代谢综合征的发病率也逐步增高,二者之间显著相关(t=-2.39,P=0.019)。与未合并代谢综合征的OSAHS患者相比,合并代谢综合征的OSAHS患者的腹围(t=-3.32,P=0.001)、体块指数(t=-3.23,P=0.002)、最低血氧饱和度(t=2.47,P=0.015)、3%氧减指数(t=-2.18,P=0.032)等均存在有统计学意义或显著统计学意义的差异。在代谢相关指标如空腹血糖、甘油三酯、高密度脂蛋白等二者之间也存在有统计学意义的差异。结论：代谢综合征是OSAHS患者的并发症之一,并随OSAHS程度加重其患病率逐步增加。腹型肥胖、夜间反复低氧血症可能是OSAHS患者并发代谢综合征的危险因素之一。 第二部分 OSAHS患者疾病严重程度临床评估的初步探讨 目的: OSAHS是多器官多系统的综合征,单一AHI指数不能全面反映其疾病严重程度,单纯依靠AHI指数判断疾病严重程度,可能会导致临床治疗的过度或不足。本研究目的是建立以并发或伴发疾病严重程度配合OSAHS基础生理指标的评估模型,以期更好的指导临床。 方法：按制定的入选与排除标准,经整夜多导睡眠监测诊断为OSAHS患者,共97例资料完整病例进入本研究。对所有病例按制定的临床评估模型进行评估,比较其结果与AHI指数及临床症状的差异性。计量数据用均数±标准差(mean±sd)表示,使用spss17.0统计软件进行数据统计与分析,采用非参数独立样本t检验比较组间差异性,P0.05,认为差异具有统计学意义,P0.01,认为差异具有高度统计学意义。 结果：按AHI指数分组,7例轻度OSAHS患者经临床评分后,有2例被评为临床中度,3例被评为重度。加分项目主要有：2例为血压升高,2例为脂代谢异常,4例为白天嗜睡明显。12例中度OSAHS患者经临床评分后,2例被评为轻度,9例被评为重度,加分项目主要有：7例为脂代谢异常,2例为血压升高,1例为糖代谢紊乱。78例重度OSAHS患者中经临床评分后,6例被评为轻度,3例被评为中度,其余被评为重度,但得分均有上升。6例被评为轻度患者均无明显并发或伴发疾病,3例被评为中度者伴发疾病为舒张压升高。在评为重度患者中普遍加分超过3以上,主要以脂代谢异常及白天嗜睡明显。少部分为血压或空腹血糖异常。经统计学处理,AHI分组评估与临床模型评估结果相比较,差异明显。 结论：以OSAHS伴发或并发疾病配合基础生理指标评分来评价0SAHS疾病严重程度明显好于单一使用AHI指数,更有利于指导临床干预。
[Abstract]:The first part
Obstructive sleep apnea hypopnea syndrome and the severity of the disease and metabolic syndrome
Objective: To evaluate the severity of obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea hypopnea syndrome, OSAHS) in patients with metabolic syndrome incidence, clinical features and influencing factors.
Methods: a retrospective analysis of 97 cases diagnosed by whole night polysomnography for OSAHS patients, according to the AHI index divided into mild to moderate (5- = AHI30), severe and very severe (30AHI55) (AHI55) 3 groups, inquiry, history of hypertension, coronary heart disease, diabetes or impaired glucose metabolism, high blood lipids or lipid metabolism abnormal history and medication history, measurement of systolic blood pressure, diastolic blood pressure, height, weight, neck circumference, waist circumference and general health. The next morning when the night sleep monitoring standard intravenous puncture of forearm venous blood fasting, fasting blood glucose detection and automatic biochemical analyzer, blood total cholesterol, glycerin three fat, high density lipoprotein cholesterol, low density lipoprotein cholesterol and other biochemical indicators. According to the "2007 Chinese adult dyslipidemia prevention guide" for the metabolic syndrome diagnosis. Analysis of incidence of different degree of metabolic syndrome in patients with OSAHS rate distribution in different groups. Point of clinical characteristics. The mean and standard deviation for the measurement data (mean + SD) said that the statistics and analysis of data using SPSS17.0 statistical software, using non parametric independent samples t test were used to compare the differences between groups, P0.05, that has statistical significance, the difference of P0.01, that the difference is highly significant.Pearson correlation test for correlation between the two sets of data. By using logistic regression analysis to exclude confounding factors impact on the results.
Results: the incidence of metabolic syndrome in the OSAHS group was 48.5%, the incidence rate of each group were: mild and moderate severe group 33.3%, group 43.3%, group 57.1%. showed very severe with the increase of AHI index, the incidence of metabolic syndrome is also gradually increased, a significant correlation between the two (t=-2.39. P=0.019). Compared with OSAHS patients without metabolic syndrome combined with metabolic syndrome in patients with OSAHS (t=-3.32, P=0.001), abdominal circumference body mass index (t=-3.23, P=0.002), the lowest oxygen saturation (t=2.47, P=0.015), 3% oxygen desaturation index (t= -2.18, P=0.032). There were differences were statistically significant or was significant. In triglyceride metabolism related indicators, such as fasting glucose, there had significant difference between high density lipoprotein two. Conclusion: the metabolic syndrome is one of the complications of OSAHS patients, and the patients with the aggravation of OSAHS The disease rate is increasing gradually. Abdominal obesity, repeated nocturnal hypoxemia may be one of the risk factors of OSAHS patients complicated with metabolic syndrome.
The second part
Preliminary study of clinical assessment of disease severity in patients with OSAHS
Objective: OSAHS syndrome is a multi organ and multi system, single AHI index can not reflect the severity of the disease, relying solely on the AHI index to judge the severity of the disease, clinical treatment may lead to excessive or insufficient. The purpose of this study is to establish concurrent or concomitant disease severity assessment with OSAHS based physiological index model, in order to better guide the clinical.
Methods: according to the inclusion and exclusion criteria, the all night polysomnography diagnosis for OSAHS patients in this study were 97 cases with complete data on all cases. According to the clinical evaluation model is formulated to evaluate compared results with AHI index and clinical symptoms. The measurement data with mean + standard the difference (mean + SD) said that the statistics and analysis of data using SPSS17.0 statistical software, using non parametric independent sample t test to compare the differences between groups, P0.05, that has statistical significance, the difference of P0.01, that the difference is highly significant.
缁撴灉锛氭寜AHI鎸囨暟鍒嗙粍,7渚嬭交搴SAHS鎮ｈ，
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