重度OSAHS患者术前CPAP治疗前后外周血中性粒细胞ROS含量及血清总抗氧能力的检测及意义
发布时间：2018-11-08 10:42
【摘要】：背景： 阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是临床常见的睡眠呼吸疾病,其病理损伤核心因素是体内长期存在的间歇低氧/再氧合环境，OSAHS可导致机体长期低氧血症、高碳酸血症、大量高度活化的氧自由基（活性氧自由基ROS等）的产生及神经体液调节机制的异常，其显著的多系统损害被认为是一种全身性疾病。目前临床上对重度OSAHS患者术前常规予3-7天CPAP治疗，以改善低氧血症、纠正睡眠结构紊乱，减少围手术期并发症的发生。 目的： 通过对重度OSAHS住院患者术前CPAP治疗前后外周血中性粒细胞内ROS含量、血清总抗氧能力及多导睡眠监测和ESS评分的对比研究，探讨术前CPAP治疗的有效性及其对心血管疾病治疗的相关机制。 方法 选择2011年10月至2012年2月在我院耳鼻咽喉-头颈外科入院的重度OSAHS患者30例，所有病例均经过多导睡眠图监测（polysomnography,PSG）确诊的重度OSAHS患者（均为男性），，诊断标准为新修订的阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南(简称指南)。体重指数31.23±2.97kg/m2，平均年龄44.5±7.9岁。入选对象除外急（慢）性炎症性疾病、慢性肝胆、肾脏、风湿性、骨骼、内分泌、生殖系统及肿瘤等疾病，术前除CPAP治疗外除外其他治疗。分别于CPAP治疗前后记录睡眠呼吸暂停低通气指数（apnea hypopneaindex,AHI）、最低血氧饱和度（lowest blood oxygen saturation，LSaO2）、平均血氧饱和度、ESS评分、以及外周血中性粒细胞ROS含量及血清总抗氧能力（T-AOC）等。中性粒细胞ROS含量检测采用流式细胞术，TAOC通过ABTS法。 结果 OSAHS患者术前短期CPAP治疗前后AHI、LSaO_2、SaO_2均值、ESS评分以及外周血中性粒细胞ROS荧光强度和血清T-AOC配对t检验，P值均小于0.05，差异均具有统计学意义。 结论 1OSAHS患者存在高水平氧化应激反应。 2术前CPAP治疗可改善患者睡眠紊乱，纠正低氧血症，改善嗜睡症状。 3术前CPAP治疗可以降低ROS含量，提高血清总抗氧能力，改善高水平氧化应激反应。 4术前CPAP治疗可辅助对OSAHS患者基础性疾病的治疗，减少围手术期并发症。
[Abstract]:Background: obstructive sleep apnea hypopnea syndrome (OSAHS) is a common clinical sleep respiratory disease. The core factor of its pathological injury is the chronic intermittent hypoxia / reoxygenation environment. OSAHS can lead to long-term hypoxemia, hypercapnia, the production of a large number of highly activated oxygen free radicals (ROS and so on) and abnormal neurohumoral regulation mechanism. The significant multi-system damage is considered to be a systemic disease. In order to improve hypoxemia, correct sleep structure disorder and reduce perioperative complications, the patients with severe OSAHS were treated with CPAP for 3-7 days before operation in order to improve hypoxemia, correct sleep structure disorder and reduce the incidence of perioperative complications. Objective: to compare the contents of ROS in peripheral blood neutrophils, total anti-oxygen ability of serum, polysomnography and ESS score in patients with severe OSAHS before and after CPAP treatment. To explore the efficacy of preoperative CPAP therapy and its related mechanisms for cardiovascular disease treatment. Methods from October 2011 to February 2012, 30 patients with severe OSAHS who were admitted to the department of otolaryngal-head and neck surgery in our hospital were selected. All the patients were diagnosed by polysomnography monitoring (polysomnography,PSG) (all male). The diagnostic criteria are the revised guidelines for the diagnosis and surgical treatment of obstructive sleep apnea hypopnea syndrome. Body mass index (BMI) was 31.23 卤2.97 kg / m2 with an average age of 44.5 卤7.9 years. The subjects were excluded from acute (chronic) inflammatory diseases, chronic hepatobiliary, renal, rheumatic, skeletal, endocrine, reproductive system and tumor diseases, with the exception of CPAP therapy before operation. Sleep apnea hypopnea index (apnea hypopneaindex,AHI), minimum oxygen saturation (lowest blood oxygen saturation,LSaO2), mean oxygen saturation, ESS score were recorded before and after treatment with CPAP. The content of ROS in peripheral blood neutrophils and total antioxidant capacity (T-AOC) in serum were also studied. The ROS content of neutrophils was detected by flow cytometry and TAOC by ABTS. Results the mean value of AHI,LSaO_2,SaO_2, ESS score, ROS fluorescence intensity of peripheral blood neutrophils and serum T-AOC pairing t test were lower than 0.05 in patients with OSAHS before and after short-term CPAP treatment (P < 0.05). The difference was statistically significant. Conclusion there is a high level of oxidative stress in patients with 1OSAHS. 2 preoperative CPAP therapy can improve sleep disorder, correct hypoxemia and improve somnolence symptoms. (3) preoperative CPAP treatment could decrease the content of ROS, improve the total antioxidant ability of serum and improve the high level of oxidative stress response. Preoperative CPAP therapy can assist in the treatment of basic diseases in patients with OSAHS and reduce perioperative complications.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R766
本文编号：2318221
[Abstract]:Background: obstructive sleep apnea hypopnea syndrome (OSAHS) is a common clinical sleep respiratory disease. The core factor of its pathological injury is the chronic intermittent hypoxia / reoxygenation environment. OSAHS can lead to long-term hypoxemia, hypercapnia, the production of a large number of highly activated oxygen free radicals (ROS and so on) and abnormal neurohumoral regulation mechanism. The significant multi-system damage is considered to be a systemic disease. In order to improve hypoxemia, correct sleep structure disorder and reduce perioperative complications, the patients with severe OSAHS were treated with CPAP for 3-7 days before operation in order to improve hypoxemia, correct sleep structure disorder and reduce the incidence of perioperative complications. Objective: to compare the contents of ROS in peripheral blood neutrophils, total anti-oxygen ability of serum, polysomnography and ESS score in patients with severe OSAHS before and after CPAP treatment. To explore the efficacy of preoperative CPAP therapy and its related mechanisms for cardiovascular disease treatment. Methods from October 2011 to February 2012, 30 patients with severe OSAHS who were admitted to the department of otolaryngal-head and neck surgery in our hospital were selected. All the patients were diagnosed by polysomnography monitoring (polysomnography,PSG) (all male). The diagnostic criteria are the revised guidelines for the diagnosis and surgical treatment of obstructive sleep apnea hypopnea syndrome. Body mass index (BMI) was 31.23 卤2.97 kg / m2 with an average age of 44.5 卤7.9 years. The subjects were excluded from acute (chronic) inflammatory diseases, chronic hepatobiliary, renal, rheumatic, skeletal, endocrine, reproductive system and tumor diseases, with the exception of CPAP therapy before operation. Sleep apnea hypopnea index (apnea hypopneaindex,AHI), minimum oxygen saturation (lowest blood oxygen saturation,LSaO2), mean oxygen saturation, ESS score were recorded before and after treatment with CPAP. The content of ROS in peripheral blood neutrophils and total antioxidant capacity (T-AOC) in serum were also studied. The ROS content of neutrophils was detected by flow cytometry and TAOC by ABTS. Results the mean value of AHI,LSaO_2,SaO_2, ESS score, ROS fluorescence intensity of peripheral blood neutrophils and serum T-AOC pairing t test were lower than 0.05 in patients with OSAHS before and after short-term CPAP treatment (P < 0.05). The difference was statistically significant. Conclusion there is a high level of oxidative stress in patients with 1OSAHS. 2 preoperative CPAP therapy can improve sleep disorder, correct hypoxemia and improve somnolence symptoms. (3) preoperative CPAP treatment could decrease the content of ROS, improve the total antioxidant ability of serum and improve the high level of oxidative stress response. Preoperative CPAP therapy can assist in the treatment of basic diseases in patients with OSAHS and reduce perioperative complications.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R766
【参考文献】
相关期刊论文 前4条
1 李润汉;曾勇;王跃建;赵远新;陈伟雄;杨芳;;重度阻塞性睡眠呼吸暂停低通气综合征围手术期的处理[J];南方医科大学学报;2006年05期
2 侯静,许媛,何伟,张彤彦,周华,叶京英;阻塞性睡眠呼吸暂停低通气综合征术后ICU治疗[J];中国耳鼻咽喉头颈外科;2004年06期
3 王红梅;王林;刘吉祥;;短期持续正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征伴2型糖尿病患者胰岛素敏感性的影响[J];临床耳鼻咽喉头颈外科杂志;2008年13期
4 陈怀京;吴延庆;王小平;丁静;曾祥毅;陈琦;;持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者血压的影响[J];中华高血压杂志;2010年07期
本文编号：2318221
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