阻塞性睡眠呼吸暂停低通气综合征患者治疗现状调查

发布时间：2018-01-16 04:14

本文关键词：阻塞性睡眠呼吸暂停低通气综合征患者治疗现状调查　出处：《广州医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的研究显示美国约90%的阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者未经临床诊断，未经治疗OSAHS患者的并发症、病死率显著增高。中国OSAHS患者的诊断率可能更低，对确诊患者的接受治疗情况还缺乏了解，我们拟调查我院经多导睡眠监测（PSG）确诊为OSAHS患者的治疗现状。方法电话回访2001年1月至2011年6月期间在广州医科大学附属第一医院睡眠中心经PSG确诊的3080例OSAHS及单纯鼾症患者接受治疗的情况，对收集的回访结果及存留的PSG报告有关资料汇总后进行相关指标的比较和统计学分析。结果 1、电话回访成功1270人，其中OSAHS患者1126人，，单纯鼾症患者144人，平均回访成功率41.23%，失访原因主要是联系方式改变，占比达82.65%； 2、627例（55.68%）OSAHS患者接受了治疗，接受单纯CPAP治疗281人（24.95%），单纯手术125人（11.10%），单纯减重84人（7.46%），综合治疗78人（6.93%），其他59人（5.24%）； 3、未治疗OSAHS患者499人（44.32%），未治疗原因为：自觉病情不重不需要治疗253人（50.70%），害怕手术及呼吸机、口腔矫治器治疗麻烦84人（16.84%），工作忙没时间75人（15.03%），担心疗效不好58人（11.62%），治疗费用昂贵29人（5.81%）； 4、单纯CPAP治疗患者睡眠质量总改善率及显著改善率分别为87.54%、48.75%，单纯手术为77.60%、34.40%，单纯减重为77.38%、19.05%，综合治疗为89.74%、50.00%；单纯CPAP和综合治疗患者睡眠质量总改善率及显著改善率比较无统计学差异（P0.05），均高于其余两种治疗方式（P0.05）；单纯手术患者与单纯减重患者比较睡眠质量总改善率无统计学差异（P0.05），显著改善率高于减重患者（P0.05），但有29例（29.90%）术后睡眠质量改善患者一段时间后出现复发； 5、采用单纯CPAP治疗患者281人，有116人（41.28%）放弃治疗，放弃原因为治疗麻烦不能坚持47人（40.52%），疗效不佳27人（23.28%），对呼吸机不耐受19人（16.38%），自觉症状改善无需治疗16人（13.79%），其他7人（6.03%）； 6、125例单纯外科手术治疗患者中，86例（68.80%）采用UPPP及改良UPPP；17例（13.60%）采用鼻腔扩容术；14例（11.20%）采用单纯扁桃体切除术；8例（6.40%）患者采用其他术式； 7、单纯鼾症和轻、中、重度及总OSAHS患者高血压患病率分别为13.19%、23.47%、29.33%、37.30%、33.21%，随OSAHS严重程度增加，高血压患病率不断升高（χ2=40.40，P0.01）；总OSAHS患者高血压患病率显著高于单纯鼾症患者（P0.01）。 8、单纯鼾症和轻、中、重度及总OSAHS患者接受治疗率分别为25.00%、35.68%、44.71%、64.96%、55.68%，随OSAHS严重程度的增加，OSAHS患者接受治疗率不断提高（χ2=116.70，P0.01）；总OSAHS患者接受治疗率显著高于单纯鼾症患者（P0.01）。 9、单纯鼾症和轻、中、重度及总OSAHS患者有高血压组接受治疗率分别为26.35%、38.00%、55.74%、73.00%、65.51%，无高血压组接受治疗率分别为24.80%、34.97%、40.14%、60.18%、51.60%。其中单纯鼾症和轻度OSAHS患者有高血压组与无高血压组比较，接受治疗率差异无统计学意义（P0.05）；中度、重度及总OSAHS患者有高血压组接受治疗率均显著高于无高血压组（P0.05）。结论 1、44.32%的OSAHS患者未采取任何治疗措施，对该疾病危害性缺乏认识是影响治疗的主要因素，呼吸机治疗麻烦、害怕手术、担心治疗效果、治疗费用昂贵亦是重要影响因素。 2、在接受治疗患者中，近半数选择CPAP治疗，可能与我院睡眠监测室归属呼吸内科有关，但约40%采用CPAP治疗的患者放弃了CPAP治疗。 3、随OSAHS严重程度及高血压患病率的增加，患者接受治疗率也不断提高。 4.本研究通过长时间、大样本资料观察确诊OSAHS患者的治疗状态，表明在中国OSAHS患者的治疗情况不容乐观，有待在加强患者对该疾病的认识，提高治疗效果等方面进行努力。
[Abstract]:objective
Research shows that about 90% of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) patients without clinical diagnosis, the treatment of OSAHS patients without complications, the mortality rate is significantly higher in patients with OSAHS. Chinese diagnostic rate may be lower, but also a lack of understanding of the patients received treatment, we intend to investigate in our hospital by polysomnography (PSG) were present in the treatment of OSAHS patients.
Method
During the period of January 2001 to June 2011 telephone interview at the Guangzhou Medical University sleep center of the First Affiliated Hospital of 3080 patients with OSAHS diagnosed by PSG and snoring patients treated, comparison and statistical analysis of return results to collect and retention PSG report relevant information after the summary of relevant indicators.
Result
1, 1270 patients were successful in telephone interviews, including 1126 OSAHS patients and 144 snoring patients. The average return visit success rate was 41.23%. The main reason for the loss of visits was the contact mode change, accounting for 82.65%.
2627 patients (55.68%) received OSAHS treatment, 281 patients received simple CPAP treatment (24.95%), 125 patients received simple surgery (11.10%), 84 patients gained weight loss (7.46%), 78 patients (6.93%) were treated by comprehensive treatment, and the other 59 patients (59).
3, 499 patients with untreated OSAHS (44.32%), no treatment due to illness is not serious: consciously do not need treatment of 253 people (50.70%), fear of surgery and ventilator, oral appliances for the treatment of trouble of 84 people (16.84%), busy no time to 75 people (15.03%), 58 people worry about bad curative effect (11.62%) the treatment is expensive, 29 people (5.81%);
4, CPAP alone, the total improvement rate and quality of sleep in patients with significant improvement rate were 87.54%, 48.75%, 77.60% and 34.40%, simple operation, simple weight loss was 77.38%, 19.05%, 89.74% and 50%; comprehensive treatment, pure CPAP and sleep quality of patients with comprehensive treatment the total improvement rate and significantly improve the rate of no significant difference (P0.05), were higher than those of the other two treatments (P0.05); simple surgery patients with simple weight loss patients sleep quality total improvement rate showed no significant difference (P0.05), significantly improve the rate of weight loss patients (P0.05), but there were 29 cases (29.90%) patients with recurrence of a period of time after surgery and improve the quality of sleep;
5, 281 patients were treated with CPAP alone. 116 patients (41.28%) gave up treatment. The reason for giving up was that they could not adhere to 47 patients (40.52%) because of treatment difficulties, 27 patients (23.28%) had poor curative effect, 19 patients (16.38%) were not intolerant of ventilator, and no symptoms were improved.
6125 cases of surgical treatment of patients, 86 cases (68.80%) by UPPP and modified UPPP; 17 cases (13.60%) with expansion nasal surgery (11.20%); 14 cases with simple tonsillectomy; 8 cases (6.40%) with other operation;
7, snoring and mild, 13.19% respectively, and the total prevalence of severe hypertension in patients with OSAHS 23.47%, 29.33%, 37.30%, 33.21%, associated with the severity of OSAHS, the prevalence rate of hypertension increased (2=40.40, P0.01); the total prevalence rate of hypertension in patients with OSAHS was significantly higher than that of simple snoring patients (P0.01).
8, simple snoring and mild, severe, and total OSAHS of patients receiving treatment rates were 25%, 35.68%, 44.71%, 64.96%, 55.68%, OSAHS increased with the severity of the treatment of patients with OSAHS rate was increased (x 2=116.70, P0.01); total OSAHS in patients was significantly higher than that of simple snoring patients (P0.01).
9, simple snoring and mild, severe, and total OSAHS in patients with hypertension group received treatment rates were 26.35%, 38%, 55.74%, 73%, 65.51%, hypertension group received treatment rates were 24.80%, 34.97%, 40.14%, 60.18%, 51.60%. simple snoring and mild OSAHS patients with hypertension group and non the hypertension group, receiving treatment there was no significant difference (P0.05); moderate, severe and total OSAHS patients with hypertension group were significantly higher than that of treatment group without hypertension (P0.05).
conclusion
1,44.32% OSAHS patients did not take any treatment measures. The lack of awareness of the risk of this disease is the main factor affecting the treatment. Breathing machine treatment is troublesome, fear of surgery, worry about the treatment effect, and the high cost of treatment is also an important factor.
2, nearly half of the patients who received CPAP treatment were probably related to the Department of respiratory medicine in our sleep monitoring room, but about 40% of patients treated with CPAP gave up CPAP treatment.
3, with the increase of the severity of OSAHS and the prevalence of hypertension, the rate of receiving treatment is also increasing.
4., the study confirmed the treatment status of OSAHS patients through long time and large sample observation. It shows that the treatment of OSAHS patients in China is not optimistic. We need to strengthen our understanding of the disease and improve the treatment effect.

【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R766

【参考文献】