阻塞性睡眠呼吸暂停综合征患者心率变异性与心律失常相关性研究

发布时间：2018-05-14 12:24

本文选题：阻塞性睡眠呼吸暂停综合征 + 心率变异性　；参考：《昆明医学院》2010年硕士论文

【摘要】： 目的:探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者心率变异性与心律失常发生的相关性,进而预测OSAS患者心律失常的发生,为监测和评估抗心律失常药物疗效有价值的临床参考信息,预防和治疗心律失常提供新的思路。方法:以2009年2月至2010年2月我院门诊和住院81例患者为研究对象,对所有患者进行一般情况,多导睡眠图监测和24小时动态心电图监测。入选患者经病史、体检、超声心动图和血生化检查,排除风湿性瓣膜性心脏病、先天性心脏病、中枢型睡眠呼吸暂停综合征(CSAS)、长期严重酗酒、严重肺部疾病、肾脏、脑部疾病,且近期无服用辅助睡眠的药物。据多导睡眠图监测,按睡眠呼吸暂停低通气指数(AHI)超过5次以上,对标准将受试者分为OSAS组(实验组)和无OSAS组(对照组)两组,其中实验组48例,男37例,女11例,年龄58-93(69.7±8.8)岁;对照组33例,男23例,女10例,年龄59-89(69.8±8.5)岁。对两组人群分别进行超声心动图检测心脏结构指标,24小时动态心电图监测获得心率变异性指标及心律失常指标,所有实验数据采用SPSSStatistics 17.0软件包处理分析,计量资料以均值±标准差((?)±s)表示,计数资料以频数表示。组间定量资料比较采用t检验,定性资料比较采用X~2检验,P＜0.05为差异有统计学意义。自变量和因变量之间相关分析,双变量为计量资料,成正态分布的,行线性相关分析(计算Pearson相关系数),对分类变量的数据或变量值的分布明显非正态或分布不明时,行秩相关法(计算Spearman相关系数)。在存在相关关系时,r≥0.7,两变量有高度相关关系;0.7＞r≥0.4,两变量有中度相关关系;r＜0.4,两变量有低度相关关系。结果:总体比较实验组与对照组在性别、年龄、身高、体重、体重指数(BMI)、腰围、臀围、腰臀比(WHR)、吸烟、饮酒、合并高血压病情况、血压(收缩压/舒张压)水平、高血压病程、降压药使用情况、合并糖尿病情况、空腹血糖(FPG)、餐后血糖(PPBS)、合并退行性心脏瓣膜病情况相比较均无统计学差异(P＞0.05)。而实验组颈围(Nc)和血液生化指标比较中的低密度脂蛋白胆固醇(LDL-c)及高敏C反应蛋白(hs-CRP)明显高于对照组(Nc:40.88±3.62 cm vs 38.12±3.45 cm;LDL-c:3.78±0.80 mmol/L vs2.99±0.89 mmol/L:hs-CRP:15.19±8.97 mmol/L vs9.42±1.92mmol/L),而高密度脂蛋白胆固醇(HDL-c)低于对照组(0.89±0.21 mmol/L vs1.10±0.23mmol/L),比较均有统计学差异(P＜0.05)。心脏结构指标中,实验组左心房内径(LAId)、右心房内径(RAId)、室间隔厚度(IVST)、左心室舒张末期内径(LVPWT)、左室肌重量(LVM)、左室肌重量指数(LVMI)均高于对照组,比较均有统计学差异(P＜0.05);心率变异性指标中,实验组R-R间期的标准差(SDNN)、5 min平均R-R间期的标准差(SDANN)低于对照组,比较均有统计学差异(P＜0.05);心律失常发生情况比较,实验组患者的心律失常(Arrhythmia)人数显著高于对照组,其中在最慢心率、最快心率、平均心率、心房颤动、心房扑动、窦性停搏、束支传导阻滞上比较无差异;实验组室性早搏、成对室性早搏、室性心动过速、室上性早搏、成对室上性早搏、室上性心动过速、房室传导阻滞发生率较对照组高,比较均有统计学差异(P＜0.05)。相关分析提示:心脏结构指标与缺氧时间指标成中度相关,与缺氧程度指标成中度相关,与缺氧综合指标成中度相关;心律失常发生与缺氧时间及缺氧程度成低到中度相关;心率变异性指标与心律失常发生成低到中度相关。结论:OSAS患者的心律失常发生率较无OSAS患者更为严重,与患者长期间歇性低氧血症和高碳酸血症相关的心脏结构改变、体液因子变化、自主神经功能紊乱等因素有关。本研究报道了OSAS患者心脏结构发生改变、心率变异性指标与心律失常发生具有相关性,这些研究结果可为临床评估OSAS患者发生心律失常风险、指导抗心律失常药物疗效的监测、改善顽固性心律失常的诊疗思路提供有价值的参考信息。
[Abstract]:Objective: To investigate the correlation between heart rate variability and arrhythmia in patients with obstructive sleep apnea syndrome (OSAS), and then to predict the occurrence of arrhythmia in OSAS patients, and to provide valuable information for monitoring and evaluating the efficacy of antiarrhythmic drugs, and to provide new ideas for preventing and treating arrhythmia.
Methods: 81 patients in our hospital from February 2009 to February 2010 were studied. The general situation, polysomnography monitoring and 24 hour ambulatory electrocardiogram monitoring were carried out for all patients. The patients were selected by medical history, physical examination, echocardiography and blood biochemical examination, excluding rheumatic valvular heart disease, congenital heart disease, central type sleep. Sleep apnea syndrome (CSAS), long term serious alcoholism, severe lung disease, kidney, brain disease, and no use of auxiliary sleep drugs in the near future. According to polysomnography monitoring, according to sleep apnea hypopnea index (AHI) more than 5 times, the standard subjects were divided into group OSAS (experimental group) and no OSAS group (control group), which was real There were 48 cases, 37 males and 11 females, 58-93 (69.7 + 8.8) years old, 33 cases in the control group, 23 men, 10 cases, 59-89 (69.8 + 8.5) years old. Echocardiography was used to detect cardiac structural indexes in the two groups, and the heart rate variability index and arrhythmia indexes were obtained by ambulatory electrocardiogram monitoring. All experimental data were SPSSStatistics 17 software package analysis, the measurement data were expressed with mean mean standard deviation ((?) + s), and the count data were expressed in frequency. The quantitative data between groups were compared with t test, qualitative data were compared with X~2 test, P < 0.05 was statistically significant. The correlation analysis between independent variables and dependent variables, bivariate as measurement data, normal distribution, line line Sex correlation analysis (calculation of Pearson correlation coefficient), when the distribution of data or variable values of classified variables is obviously unnormal or unidentified, the line rank correlation method (calculated Spearman correlation coefficient). In the presence of correlation, R > 0.7, two variables have high correlation; 0.7 > R > 0.4, two variables have moderate correlation; R < 0.4, two variable is low Degree correlation.
Results: the overall comparison between the experimental group and the control group was in sex, age, height, weight, body mass index (BMI), waist circumference, hip circumference, waist to hip ratio (WHR), smoking, drinking, hypertension, blood pressure (systolic pressure / diastolic pressure), hypertension course, use of antihypertensive drugs, combined diabetes, fasting blood glucose (FPG), postprandial blood glucose (PPBS), combined regression. There was no significant difference in the conditions of cardiac valvular heart disease (P > 0.05). The low density lipoprotein cholesterol (LDL-c) and the high sensitive C reactive protein (hs-CRP) in the comparison of neck circumference (Nc) and blood biochemical indexes in the experimental group were significantly higher than those in the control group (Nc:40.88 + 3.62 cm vs 38.12 + 3.45 cm; LDL-c:3.78 + 0.80 mmol/L vs2.99 0.89 0.89 19 + 8.97 mmol/L vs9.42 + 1.92mmol/L), while high density lipoprotein cholesterol (HDL-c) was lower than that of the control group (0.89 + 0.21 mmol/L vs1.10 + 0.23mmol/L), and there were statistically significant differences (P < 0.05). The left atrium diameter (LAId), right atrium diameter (RAId), ventricular septum thickness (IVST), and the left ventricular end diastolic diameter (LVPWT) were in the experimental group. The weight of left ventricular muscle (LVM) and left ventricular muscle weight index (LVMI) were all higher than those in the control group (P < 0.05). In the heart rate variability index, the standard deviation of the R-R interval of the experimental group (SDNN), the standard deviation of the average R-R interval of the 5 min (SDANN) were lower than that of the control group (P < 0.05), and the occurrence of arrhythmia was compared. The number of patients with arrhythmia (Arrhythmia) was significantly higher than that in the control group, of which there were no differences in the slowest heart rate, the fastest heart rate, the average heart rate, atrial fibrillation, atrial flutter, sinus arrest, and bundle branch block, and experimental ventricular premature beat, ventricular premature beat, ventricular tachycardia, supraventricular sexual premature beat, supraventricular sex, and supraventricular sex. The incidence of atrioventricular block was higher than that of the control group (P < 0.05). The correlation analysis showed that the cardiac structural index was moderately correlated with the hypoxia time index, moderately related to the hypoxia index and moderate correlation with the hypoxia comprehensive index, and the occurrence of arrhythmia was lower to the hypoxic time and the degree of hypoxia. Heart rate variability was associated with low and moderate cardiac arrhythmias.
Conclusion: the incidence of arrhythmia in OSAS patients is more severe than that in non OSAS patients. It is related to cardiac structural changes, changes of body fluid factors and autonomic nervous dysfunction associated with chronic intermittent hypoxemia and hypercapnia. This study reports the changes in cardiac structure, heart rate variability and arrhythmia in OSAS patients. These results can be used to evaluate the risk of arrhythmia in OSAS patients, to guide the monitoring of the efficacy of antiarrhythmic drugs and to provide valuable information for improving the diagnosis and treatment of intractable arrhythmia.

【学位授予单位】：昆明医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R541.7;R766

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