阻塞性睡眠呼吸暂停低通气综合征患者心律失常的临床分析

发布时间：2018-03-11 05:38

  本文选题：睡眠呼吸暂停低通气综合征　切入点：阻塞性　出处：《福建医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的:分析阻塞性睡眠呼吸暂停低通气综合征( Obstructive sleep apnea-hypopnea syndrome,OSAHS)患者心律失常发生情况,探讨OSAHS相关心律失常的可能机制。 方法:收集2010年2月至2011年5月就诊于福建省立医院主诉睡眠打鼾的87例门诊和住院患者病史资料,同步进行整夜多导睡眠图(polysomnography,PSG)和24小时动态心电图监测。根据睡眠监测结果分两组:OSAHS组共55例(apnea hypopnea index ,AHI"g5)对照组为单纯鼾症组共32例(AHI5)。其中,OSAHS组按AHI值再分为:轻度OSAHS(5≤AHI≤20)13例,中度OSAHS(21≤AHI≤40)16例;重度OSAHS (AHI40)26例。比较两组睡眠呼吸紊乱情况,比较不同程度OSAHS患者心律失常的发生率、心律失常类型,采用心率变异性分析评价OSAHS患者自主神经功能变化,探讨OSAHS患者心律失常的可能机制。 结果:1.本研究中OSAHS组绝大多数为中年男性患者,体重指数、上气道解剖异常的比例较单纯鼾症组增加(p 0.05),嗜睡程度(Epworth sleepiness scale, ESS评分)较单纯鼾症组加重(p 0.05);2. OSAHS组呼吸紊乱次数(AHI)较单纯鼾症组明显增高,低氧的程度(LSPO_2、ASPO_2均下降)较单纯鼾症组严重,低氧的持续时间(LAT、AAT、PSPO_290、TSPO_290均增加)较单纯鼾症组延长(p 0.05);3.OSAHS组睡眠觉醒指数增加,睡眠N3期比例下降(p 0.05)。4. OSAHS患者心律失常的发生率为54.6%。快速性心律失常以偶发室上性早搏(47.3%)和室性早搏(23.6%)最常见;缓慢性心律失常如心动过缓、房室传导阻滞、窦性停搏、逸搏心律多见于重度OSAHS患者;14.5%OSAHS患者出现联合心律失常。5.OSAHS组夜间TP、VLF、LF、HF均较单纯鼾症组高(p 0.05),全天的平均心率高于单纯鼾症组(p 0.05)。 结论:1. OSAHS患者夜间有明显低氧血症,睡眠中觉醒增加,深睡眠比例下降。OSAHS患者夜间交感、副交感神经调控作用均增加,并以交感神经调控作用增加占优势。2.OSAHS患者心律失常发生率为54.6%。心律失常的类型以室上性和室性早搏最常见。而缓慢性心律失常多见于重度OSAHS患者。随着OSAHS病情的加重,心律失常的复杂及严重程度增加。3.OSAHS相关的心律失常可能与低氧和自主神经功能紊乱有关。
[Abstract]:Objective: to analyze the incidence of arrhythmias in patients with Obstructive sleep apnea-hypopnea syndrome (OSAHS) and to explore the possible mechanism of OSAHS related arrhythmias. Methods: from February 2010 to May 2011, 87 outpatients and inpatients with sleep snoring who were admitted to Fujian Provincial Hospital were collected. The polysomnography (PSG) and 24 hour ambulatory electrocardiogram (ECG) were performed simultaneously. According to the results of sleep monitoring, 55 cases of hypopnea index AHI "g5" were divided into two groups. The control group consisted of 32 patients with simple snoring. According to the AHI value, OSAHS group was subdivided into two groups: mild OSAHS(5 鈮，

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