阻塞性睡眠呼吸暂停低通气综合征低氧血症评价指标研究

发布时间：2018-06-10 11:59

本文选题：呼吸暂停低通气综合征 + 低氧血症　；参考：《大连医科大学》2011年硕士论文

【摘要】：目的:探讨阻塞型睡眠呼吸暂停低通气综合征(OSAHS)中低氧血症的评价指标。以往夜间低氧血症的诊断及分度指标为最低血氧饱和度,85%最低血氧饱和度90%为轻度,65%最低血氧饱和度85%为中度,最低血氧饱和度65%为重度。在临床工作中发现低氧血症的分度常常与呼吸暂停低通气综合征的分度不符或矛盾,此次研究的目的为在清醒时血氧饱和度、最低血氧饱和度、最长呼吸暂停时血氧饱和度、最长低通气时血氧饱和度、T90(血氧低于90%以下的总时间占睡眠总时间的百分比,以下T85等名称与此相同)、T85、T80、T75、T70、T65、T60众多指标中探讨更加符合实际情况,更加科学、合理反应睡眠中低氧情况的评价指标。根据不同阶段低氧对患者病理生理损害的不同程度、低氧持续时间设立加权低氧血症时间占睡眠总时间百分比,探讨该指标与AHI(呼吸紊乱指数)的相关性,是否可以成为诊断低氧血症及病情分度的评判标准,相较于现有其他指标是否存在优越性。方法:从沈阳军区总医院2010年1月至2011年3月行睡眠呼吸监测的病例中随机抽取79分成年男性病例,年龄19~62(40.92±11.57)岁,BMI (体质指数)18.72~36.63(28.16±3.36)kg/m2。其中轻度11例,中度25例,重度43例。对年龄、BMI、最低血氧饱和度、清醒时血氧饱和度、最长低通气时血氧饱和度、最长呼吸暂停时血氧饱和度、T90、T85、T80、T75、T70、T65、T60、以及加权低氧血症时间占睡眠总时间百分比做轻、中、重度三组之间的描述性分析,判断是否存在组间差异。将最低血氧饱和度、清醒时血氧饱和度、最长低通气时血氧饱和度、最长呼吸暂停时血氧饱和度、T90、T85、T80、T75、T70、T65、T60、以及加权低氧血症时间占睡眠总时间百分比与AHI做相关性分析,探讨与AHI是否存在相关性,相关性的大小。在各项与AHI明显相关的指标中做多因回归分析,确定与AHI相关性最佳,影响最大的指标即诊断低氧血症及判别低氧血症程度的指标。结果:1.OSAHS患者轻、中、重度三组之间年龄(岁)(轻度46.00±14.17,中度41.32±10.02,重度39.40±11.58,F=1.46,P=0.240.05)、清醒时血氧饱和度(%)(轻度84.91±27.92,中度93.44±02.26,重度92.74±02.17,F=0.98,P=0.380.05)、BMI(kg/m2()轻度27.58±4.65,中度28.17±2.99,重度28.31±3.25,F=0.61,P=0.550.05)、最长低通气时血氧饱和度(轻度0.78±.094,中度0.73±0.12,重度0.61±0.14,F=1.84,P=0.170.05)、T75(轻度0.00±0.00,中度0.03±0.07,重度0.04±0.05,F=2.29,P=0.110.05)、T70(轻度0.00±0.00,中度0.02±0.05,重度0.01±0.02,F=0.98,P=0.380.05)、T65(轻度0.00±0.00,中度0.00±0.00,重度0.00±0.00,F=1.01,P=0.370.05)、T60(轻度0.00±0.00,中度0.00±0.01,重度0.00±0.01,F=0.43,P=0.640.05)不存在统计学差异;轻、中、重度OSAHS患者之间最低血氧饱和度(轻度90.27±4.45,中度85.60±18.53,重度76.37±20.05,F=12.31,P=0.000.05)、最长呼吸暂停时血氧饱和度(轻度74.45±36.94,中度87.20±18.48,重度86.77±14.34,F=3.59,P=0.030.05)、T90(轻度0.21±0.24,中度0.18±0.20,重度0.44±0.19,F=15.80,P=0.000.05)、T85(轻度0.03±0.11,中度0.06±0.13,重度0.18±0.13,F=10.39,P=0.000.05)、T80(轻度0.00±0.00,中度0.04±0.10,重度0.09±0.09,F=5.49,P=0.010.05)、加权低氧血症时间占睡眠总时间百分比(轻度0.22±0.26,中度0.20±0.23,重度0.47±0.20,F=14.22,P=0.000.05)存在统计学差异。 2.最低血氧饱和度(r=-0.48,P=0.000.05)、最长呼吸暂停时血氧饱和度(r=-0.32,P=0.000.05)、T90(r=0.56,P=0.000.05)、T85(r=-0.56,P=0.000.05)、T80(r=0.45,P=0.000.05)、T75(r=0.29,P=0.010.05)、加权低氧血症时间占睡眠总时间百分比(r=0.55,P=0.000.05)与AHI存在相关性;清醒时学氧饱和度(r=0.10,P=0.380.05)、最长低通气时血氧饱和度(r=0.06,P=0.600.05)、T70(r=0.09,P=0.430.05)、T65(r=-0.03,P=0.810.05)、T60(r=0.12,P=0.280.05)与AHI不存在相关性。 3.经多因回归分析,对与AHI相关的各项指标进行多因回归分析,在P≤0.05纳入方程,P≥0.1时排除方程水平,只有加权低氧血症时间占睡眠总时间百分比被选入方程,其复相关系数为0.54,显著性检验,F=30.87,P=0.00,因此加权低氧血症时间占睡眠总时间百分比与AHI紧密相关。结论: 1.最低血氧饱和度在OSAHS轻、中、重度三组患者之间存在差异,与AHI存在相关性,但并非相关性最明显因素,以其作为诊断低氧血症的评判指标存在缺陷。 2.T90、T85对于低氧血症的评价明显优于最低血氧饱和度。 3.经多因回归分析,加权低氧血症时间占睡眠总时间百分比为影响AHI最大的因素,优于T90和T80,可能成为评价低氧血症的最佳指标。
[Abstract]:Objective: To investigate the evaluation index of hypoxemia in obstructive sleep apnea hypopnea syndrome (OSAHS). The diagnosis and graduation index of nocturnal hypoxemia were minimum oxygen saturation, 85% lowest oxygen saturation 90% was mild, 65% lowest oxygen saturation 85% was moderate, and the lowest oxygen saturation 65% was severe in clinical work. The degree of hypoxemia is often inconsistent with the degree of apnea hypopnea syndrome. The purpose of this study is to be conscious of the saturation of blood oxygen, the minimum oxygen saturation, the saturation of blood oxygen at the longest apnea, the oxygen saturation of the longest hypoventilation, and the total time of T90 (less than 90% of the blood oxygen, the percentage of the total sleep time). T85, T80, T80, T75, T70, T65, T60 are more suitable for the actual situation, more scientific and reasonable response to the evaluation of low oxygen conditions in sleep. According to the different stages of hypoxia on the patient's pathophysiological damage, the duration of hypoxic duration setting up the time of weighted hypoxemia is the total sleep time. The correlation between the index and the AHI (respiratory disorder index) can be considered as a criterion for diagnosis of hypoxemia and the degree of disease.
Methods: 79 adult male cases were randomly selected from the Shenyang military area general hospital from January 2010 to March 2011, with age 19~62 (40.92 + 11.57) years, BMI (body mass index) 18.72~36.63 (28.16 + 3.36) kg/m2., 11 mild, moderate 25, and severe 43. The age, BMI, minimum oxygen saturation, and conscious blood oxygen saturation The percentage of oxygen saturation, T90, T85, T80, T75, T70, T65, T60, and weighted hypoxemia time accounted for the total sleep time percentage of the three groups to determine whether there was a difference between groups.
The minimum blood oxygen saturation, sober blood oxygen saturation, blood oxygen saturation in the longest hypoventilation, the blood oxygen saturation in the longest apnea, T90, T85, T80, T75, T70, T65, T60, and weighted hypoxemia time accounted for the total sleep time percentage with AHI, and the correlation between AHI and the size of AHI was discussed.
Multiple regression analysis was done in all the AHI related indexes, and the best correlation was determined with AHI, and the most influential index was the diagnosis of hypoxemia and the degree of hypoxemia.
Results: the age of three groups of 1.OSAHS patients was light, moderate, and severe (46 + 14.17, moderate 41.32 + 10.02, severe 39.40 + 11.58, F=1.46, P=0.240.05), and the saturation of oxygen (%) in sober (% 84.91 + 27.92, moderate 93.44 + 2.26, severe 92.74 + 2.17, F=0.98, P=0.380.05), BMI (kg/m2), mild 14.17 .25, F=0.61, P=0.550.05), blood oxygen saturation (mild 0.78 +.094, moderate 0.73 + 0.12, severe 0.61 + 0.14, F=1.84, P=0.170.05), T75 (mild 0 + 0, moderate 0.03 + 0.07, severe 0.04 + 0.73, F=2.29, P=0.110.05), T70 (mild 0 + 0, moderate, F=0.98, F=0.98, P=0.380.05) Degree 0 + 0, severe 0 + 0, F=1.01, P=0.370.05), T60 (mild 0 + 0, moderate 0 + 0.01, severe 0 + 0.01, F=0.43, P=0.640.05), there was no statistical difference, and the minimum oxygen saturation (mild 90.27 + 4.45, moderate 85.60 + 0, F=12.31, P=0.000.05) between moderate and severe OSAHS patients, and the longest apnea Oxygen saturation (mild 74.45 + 36.94, moderate 87.20 + 18.48, severe 86.77 + 14.34, F=3.59, P=0.030.05), T90 (mild 0.21 + 0.24, moderate 0.18 + 0.20, severe 0.44 + 0.19, F=15.80, P=0.000.05), T85 5.49, P=0.010.05), the time of weighted hypoxemia accounted for the percentage of total sleep time (mild 0.22 + 0.26, moderate 0.20 + 0.23, severe 0.47 + 0.20, F=14.22, P=0.000.05), and there were statistical differences.
2. r=-0.48 (P=0.000.05), r=-0.32 (P=0.000.05), T90 (r=0.56, P=0.000.05), T85 (r=-0.56, P=0.000.05), T80 (r=0.45, P=0.000.05), the percentage of weighted hypoxemia in total sleep time Oxygen saturation (r=0.10, P=0.380.05), blood oxygen saturation (r=0.06, P=0.600.05), T70 (r=0.09, P=0.430.05), T65 (r=-0.03, P=0.810.05), T60 (r=0.12,) are not associated with the longest hypoventilation.
3. by multiple regression analysis, the multiple regression analysis of all the indexes related to AHI was carried out. The equation was included in the P < < < 0.05. The level of the equation was excluded when P was more than 0.1. Only the weighted hypoxemia time was selected as the percentage of the total sleep time, and its complex correlation coefficient was 0.54, significant examination, F=30.87, P=0.00, so the time of weighted hypoxemia accounted for sleep. The percentage of total sleeping time was closely related to AHI.
Conclusion: 1. the lowest oxygen saturation of the three groups is different in OSAHS, moderate and severe, and there is a correlation with AHI, but it is not the most obvious factor of the correlation, and there is a defect in the evaluation of the diagnosis of hypoxemia.
2.T90 and T85 were superior to the lowest oxygen saturation in the evaluation of hypoxemia.
3. by multiple regression analysis, the percentage of weighted hypoxemia in total sleep time is the biggest factor affecting AHI, which is superior to T90 and T80, and may be the best indicator of hypoxemia.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766

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