阻塞性睡眠呼吸暂停低通气综合征与肺动脉高压的研究

发布时间：2018-04-20 12:19

本文选题：阻塞性睡眠呼吸暂停低通气综合征 + 肺动脉高压　；参考：《天津医科大学》2012年硕士论文

【摘要】：目的 1.探讨阻塞性睡眠呼吸暂停低通气综合征患者肺动脉高压和肺心病的发生率,并对其相关危险因素进行研究,预测其对肺动脉高压发生、发展的影响。 2.OSAHS合并肺动脉高压、肺心病的患者经CPAP治疗1个月、3个月后肺动脉收缩压、右室前壁厚度的变化,探讨其治疗效果。方法 1.经多导睡眠监测确诊为OSAHS的患者行彩色多普勒超声心动图检查,根据彩色多普勒超声心动图PASP将OSAHS患者分对照组和肺动脉高压组(PAH)。比较两组患者呼吸紊乱指标有无差别。 2.将CPAP治疗的肺动脉高压组患者分为3组：①轻度肺动脉高压组；②中重度肺动脉高压组；③肺心病组：肺动脉高压同时有右心结构改变患者。观察治疗前后肺动脉收缩压和右室前壁厚度的变化。结果 1.389例单纯睡眠呼吸暂停患者中,91例合并有肺动脉高压,38例合并有肺心病,肺动脉高压和肺心病的发病率分别为23%、9.8%。 2.PAH患者TST-SpO280%明显高于对照组,平均SpO2、最低SpO2明显低于对照组,差别有统计学意义(P0.05)；两组患者TST-SpO290%相比差别无统计学意义(P0.05)。 3.PAH组患者TST-A、AHI、最大氧减明显高压对照组,差别有统计学意义(P0.05)。两组患者TST-HY相比,差别无统计学意义(P0.05), 4.多因素二分类Logistic回归分析,提示TST-A、AHI、平均SpO2可作为OSAHS并发肺动脉高压的危险因素(P0.05)。 5.伴有肺动脉高压的OSAHS患者CPAP治疗1个月和治疗前相比,PASP无明显降低,差别无统计学意义(P0.05),AHI及平均SpO2有所改善,差别有统计学意义(P0.05)。治疗3个月后与治疗前相比,PASP明显降低,差别有统计学意义(P0.05),AHI及平均SpO2明显改善,差别有统计学意义(P0.05)。 6.伴有肺心病的OSAHS患者CPAP治疗1个月和治疗前相比,PASP无明显降低,差别无统计学意义(P0.05)。右室前壁厚度无明显减少,差别无统计学意义(P0.05)。CPAP治疗3个月与治疗前相比,PASP明显降低,差别有统计学意义(P0.05),右室前壁厚度明显减少,差别有统计学意义(P0.05)。结论 1.OSAHS是肺动脉高压肺心病的独立危险因素,23%的OSAHS并发肺动脉高压,9.8%的OSAHS并发肺心病。 2.TST-A、AHI、平均Sp02是OSAHS并发肺动脉高压的独立危险因素。 3.对于合并肺动脉高压和(或)肺心病的OSAHS患者,CPAP是降低其肺动脉压力、改善右心结构的有效手段,经过CPAP长期治疗,肺血管重构及右心结构肥厚能够发生逆转。
[Abstract]:Purpose 1. To investigate the incidence of pulmonary hypertension and cor pulmonale in patients with obstructive sleep apnea hypopnea syndrome (OSAS). Patients with 2.OSAHS complicated with pulmonary hypertension and cor pulmonale were treated with CPAP for 1 month. After 3 months, the changes of pulmonary artery systolic pressure and the thickness of the anterior wall of right ventricle were studied. Method 1. The patients with OSAHS diagnosed by polysomnography were examined by color Doppler echocardiography. According to the color Doppler echocardiography (PASP), the patients with OSAHS were divided into control group and pulmonary hypertension group. To compare the difference of respiratory disorders between the two groups. 2. The patients with pulmonary hypertension treated with CPAP were divided into 3 groups: 1 / 1 mild pulmonary hypertension group, 2 moderate and severe pulmonary hypertension group and 3 cor pulmonale group: pulmonary hypertension patients with right heart structure change. Pulmonary artery systolic pressure and right ventricular anterior wall thickness were observed before and after treatment. Result Of the 1.389 patients with simple sleep apnea, there were 91 cases with pulmonary hypertension and 38 cases with pulmonary heart disease. The incidence of pulmonary hypertension and cor pulmonale were 239.8%. TST-SpO 280% in 2.PAH patients was significantly higher than that in the control group (P 0.05), the average SPO 2 and the lowest SpO2 were significantly lower than those in the control group (P 0.05), but there was no significant difference between the two groups in TST-SpO 290%. In the 3.PAH group, the maximal oxygen reduction was significantly higher than that in the control group (P 0.05). There was no significant difference in TST-HY between the two groups (P 0.05). 4. The multivariate two-classification Logistic regression analysis suggested that the average SpO2 could be used as a risk factor for OSAHS complicated with pulmonary hypertension (P0.05). 5. There was no significant decrease of CPAP in OSAHS patients with pulmonary hypertension after 1 month compared with that before treatment. The difference was not statistically significant (P 0.05) and the average SpO2 was improved (P 0.05). After 3 months of treatment, PASP was significantly lower than that before treatment, the difference was statistically significant (P 0.05) and the average SpO2 was significantly improved (P 0.05). 6. The CPAP of OSAHS patients with cor pulmonale was not significantly lower than that before treatment for 1 month, and the difference was not statistically significant (P 0.05). There was no significant difference in the thickness of anterior wall of right ventricle. The difference was not statistically significant. The PASP was significantly lower than that before treatment for 3 months. The difference was statistically significant (P 0.05) and the thickness of anterior wall of right ventricle was significantly decreased (P 0.05). Conclusion 1.OSAHS is an independent risk factor for pulmonary hypertension pulmonary heart disease. 23% of OSAHS complicated with pulmonary hypertension and 9.8% of OSAHS complicated with cor pulmonale. 2. Average Sp02 was an independent risk factor for OSAHS complicated with pulmonary hypertension. 3. OSAHS in patients with pulmonary hypertension and / or cor pulmonale is an effective method to reduce pulmonary artery pressure and improve the structure of right heart. After long-term treatment of CPAP, pulmonary vascular remodeling and hypertrophy of right heart structure can be reversed.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R766

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