同期多平面联合手术治疗阻塞性睡眠呼吸暂停低通气综合征及手术前后瘦素浓度变化的研究
发布时间：2019-07-09 06:12
【摘要】：阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)是临床上最常见的睡眠呼吸障碍疾病之一。该病发病率较高,美国的流行病调查发现50岁的人群中2%的女性及4%的男性有呼吸暂停的症状。随着社会生活节奏的加快,该病的发病率也明显增加,而且发病年龄逐渐年轻化。OSAHS患者不仅睡眠打鼾、呼吸暂停,同时白天嗜睡、精神不振,长期的患有该病还会导致高血压、心脏病、糖尿病、脑血管疾病等,严重危害患者的身体健康。 尽管OSAHS的病理生理机制尚不完全清楚,但是睡眠中反复出现的部分或完全上气道塌陷可导致OSAHS是确定的。发生在任何平面的上气道塌陷,包括鼻腔,咽(鼻咽,口咽和喉咽),喉腔都可导致OSAHS的发生。上气道塌陷可能是单个平面也可能是多个平面。OSAHS外科治疗的目的是扩大气道和防止气道塌陷,手术的关键是需要确定所有的阻塞平面并解除相应狭窄平面。当然OSAHS手术的成功不仅仅与阻塞部位及阻塞程度有关,还与患者自身的情况相关。对于经过选择的OSAHS患者,手术治疗效果显著,长期疗效和持续气道正压通气(Continuous positive airway pressure, CPAP)的效果相当。 OSAHS手术治疗的方式发展迅速,由最初的悬雍垂腭咽成型术,发展到舌骨悬吊、颏前、舌根部分切除等,手术复杂程度也大大增加,由原先的单一腭咽平面手术发展到多平面手术。很多OSAHS患者往往存在多平面阻塞,特别是重度OSAHS患者。同期手术一方面可以解除所有的狭窄平面,手术疗效确切,另一方面可以避免分次手术给患者带来的痛苦及经济负担。 肥胖特别是中心型肥胖是公认导致OSAHS的最重要的原因之一,50%以上的OSAHS患者肥胖,而肥胖患者中约有10%～20%患有OSAHS。OSAHS患者颈围较大,咽旁间隙脂肪沉积较多,气道狭窄,气道壁的顺应性大,气道容易塌陷。OSAHS患者也常伴有内脏脂肪的堆积,这将导致肺容积减少,造成吸气时下呼吸道对主气管和上气道的纵向牵拉作用减弱,使咽壁顺应性增大。OSAHS患者较正常人的颈围、腰围及腰臀比要大,也表明更多的脂肪沉积,而且更容易沉积在颈部及腹部。 瘦素(leptin)是一种由肥胖基因(ob)编码的激素,主要由白色脂肪细胞分泌。瘦素的作用包括抑制食欲、减少能量摄取、促进脂肪分解和抑制脂肪合成、调节糖代谢的平衡等。许多研究均表明OSAHS患者血清瘦素浓度比正常者高,而且其水平随OSAHS的严重程度增加,和呼吸暂停低通气指数(Apnea hypopnea index,AHI)呈正相关。同时瘦素浓度和体重指数呈正相关,并可反映体内脂肪的含量。在OSAHS发病机制中,瘦素起到重要作用,绝大多数OSAHS患者同时存在血清瘦素浓度的增高和瘦素抵抗,两者往往互相影响,导致恶性循环。OSAHS患者血清瘦素水平升高的原因很多,可能因为上气道炎症、交感神经活性增加、瘦素的分泌节律打断,另外OSAHS患者血清瘦素可防止呼吸抑制的发生,是一种保护机制。瘦素的抵抗机制不完全明了,可能的原因有患者体内存在瘦素抗体或拮抗物、瘦素的运输通道障碍、瘦素信号转导通路缺陷、瘦素受体缺乏或受体突变不能发挥作用等。 本研究主要探讨同期多平面手术治疗OSAHS患者的治疗方式及手术疗效等。观察OSAHS患者及OSAHS术后患者与正常人体内血清瘦素水平的变化,以便了解OSAHS患者手术后瘦素水平变化及手术对于OSAHS患者体内瘦素水平的影响,以期对于OSAHS的流行性调查及手术效果的评价等作出相应指导。
[Abstract]:Obstructive sleep apnea-hypoventilation syndrome (OSAHS) is one of the most common sleep disordered breathing disorders in the world. The incidence of the disease is high, and the epidemiological survey in the United States found that 2% of the 50-year-old population and 4% of men had symptoms of apnea. With the rapid development of the social life rhythm, the incidence of the disease is also obviously increased, and the age of the disease is gradually younger. OSAHS patients not only sleep snoring, apnea, but also daytime sleepiness, lassitude, long-term suffering from the disease can also cause hypertension, heart disease, diabetes, cerebrovascular disease, etc., and seriously endanger the health of the patients. Although the pathophysiological mechanism of OSAHS is not completely clear, the repeated partial or complete upper airway collapse in sleep may result in OSAHS determination . The upper airway collapse in any plane, including the nasal cavity, the pharynx (nasopharynx, oropharynx, and the throat), can lead to the delivery of the OSAHS Students. The upper airway collapse may be a single plane or multiple levels The purpose of the OSAHS surgical treatment is to enlarge the airway and prevent the airway collapse, and the key to the procedure is to determine all the occlusion planes and to release the corresponding stenosis Face. Of course, the success of the OSAHS operation is not only related to the blocking position and the degree of blockage, but also with the patient's own condition Closed. The effect of significant, long-term efficacy and continuous positive airway pressure (CPAP) for selected OSAHS patients When the operation of OSAHS was developed rapidly, the operation complexity of the operation was greatly increased, and the original single oropharynx plane operation was developed to the level of multi-level after the initial suspension of the uvula, the development of the suspension of the hyoid bone, the partial removal of the tongue and the like. Surface surgery. Many OSAHS patients often have multi-plane occlusion, especially severe OSAH S patients. In the same period, all the narrow planes can be released, the operation effect is exact, and on the other hand, the pain and the pain caused by the graded operation can be avoided. Obesity, in particular, is one of the most important causes of OSAHS, and more than 50% of the OSAHS patients are obese, and about 10% to 20% of the obese patients suffer from OSAHS. OSAHS patients have a large neck circumference, more fat deposits in the parapharyngeal space, stenosis of the airway, large compliance of the airway wall, OSAHS patients are often accompanied by the accumulation of visceral fat, which will result in a reduction in the volume of the lung resulting in a reduction in the longitudinal pull of the main and upper airways in the lower respiratory tract, making the pharyngeal wall The compliance was increased. The neck circumference, waist and waist-to-hip ratio of the patients with OSAHS were higher than that of normal persons, and it also indicated that more fat was deposited and more easily deposited. The neck and the abdomen. Leptin is a hormone encoded by the obesity gene (ob), mainly from white The effects of leptin include inhibiting appetite, reducing energy uptake, promoting lipolysis, and inhibiting fat synthesis, regulation, The balance of sugar metabolism and the like. Many studies have shown that the serum leptin concentration in the OSAHS patients is higher than that of the normal, and its level increases with the severity of the OSAHS, and the Apnea hyopnea index, A The level of leptin and body mass index are positively correlated and can be reflected In the pathogenesis of OSAHS, leptin plays an important role in the pathogenesis of OSAHS. in addition, that serum leptin in the OSAHS patient can prevent the occurrence of respiratory depression, It is a protective mechanism. The resistance mechanism of leptin is not completely clear, and may be caused by the presence of leptin antibody or antagonist in the patient, the transport channel disorder of leptin, the deficiency of leptin signal transduction pathway, the lack of leptin receptor or the receptor mutation, This study mainly discusses the treatment of OSAHS patients by multi-plane operation in the same period. To investigate the changes of serum leptin level in patients with OSAHS and OSAHS in patients with OSAHS and the effect of the operation on the level of leptin in the patients with OSAHS, with a view to the epidemic investigation and surgical effect of OSAHS.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R766
本文编号：2511915
[Abstract]:Obstructive sleep apnea-hypoventilation syndrome (OSAHS) is one of the most common sleep disordered breathing disorders in the world. The incidence of the disease is high, and the epidemiological survey in the United States found that 2% of the 50-year-old population and 4% of men had symptoms of apnea. With the rapid development of the social life rhythm, the incidence of the disease is also obviously increased, and the age of the disease is gradually younger. OSAHS patients not only sleep snoring, apnea, but also daytime sleepiness, lassitude, long-term suffering from the disease can also cause hypertension, heart disease, diabetes, cerebrovascular disease, etc., and seriously endanger the health of the patients. Although the pathophysiological mechanism of OSAHS is not completely clear, the repeated partial or complete upper airway collapse in sleep may result in OSAHS determination . The upper airway collapse in any plane, including the nasal cavity, the pharynx (nasopharynx, oropharynx, and the throat), can lead to the delivery of the OSAHS Students. The upper airway collapse may be a single plane or multiple levels The purpose of the OSAHS surgical treatment is to enlarge the airway and prevent the airway collapse, and the key to the procedure is to determine all the occlusion planes and to release the corresponding stenosis Face. Of course, the success of the OSAHS operation is not only related to the blocking position and the degree of blockage, but also with the patient's own condition Closed. The effect of significant, long-term efficacy and continuous positive airway pressure (CPAP) for selected OSAHS patients When the operation of OSAHS was developed rapidly, the operation complexity of the operation was greatly increased, and the original single oropharynx plane operation was developed to the level of multi-level after the initial suspension of the uvula, the development of the suspension of the hyoid bone, the partial removal of the tongue and the like. Surface surgery. Many OSAHS patients often have multi-plane occlusion, especially severe OSAH S patients. In the same period, all the narrow planes can be released, the operation effect is exact, and on the other hand, the pain and the pain caused by the graded operation can be avoided. Obesity, in particular, is one of the most important causes of OSAHS, and more than 50% of the OSAHS patients are obese, and about 10% to 20% of the obese patients suffer from OSAHS. OSAHS patients have a large neck circumference, more fat deposits in the parapharyngeal space, stenosis of the airway, large compliance of the airway wall, OSAHS patients are often accompanied by the accumulation of visceral fat, which will result in a reduction in the volume of the lung resulting in a reduction in the longitudinal pull of the main and upper airways in the lower respiratory tract, making the pharyngeal wall The compliance was increased. The neck circumference, waist and waist-to-hip ratio of the patients with OSAHS were higher than that of normal persons, and it also indicated that more fat was deposited and more easily deposited. The neck and the abdomen. Leptin is a hormone encoded by the obesity gene (ob), mainly from white The effects of leptin include inhibiting appetite, reducing energy uptake, promoting lipolysis, and inhibiting fat synthesis, regulation, The balance of sugar metabolism and the like. Many studies have shown that the serum leptin concentration in the OSAHS patients is higher than that of the normal, and its level increases with the severity of the OSAHS, and the Apnea hyopnea index, A The level of leptin and body mass index are positively correlated and can be reflected In the pathogenesis of OSAHS, leptin plays an important role in the pathogenesis of OSAHS. in addition, that serum leptin in the OSAHS patient can prevent the occurrence of respiratory depression, It is a protective mechanism. The resistance mechanism of leptin is not completely clear, and may be caused by the presence of leptin antibody or antagonist in the patient, the transport channel disorder of leptin, the deficiency of leptin signal transduction pathway, the lack of leptin receptor or the receptor mutation, This study mainly discusses the treatment of OSAHS patients by multi-plane operation in the same period. To investigate the changes of serum leptin level in patients with OSAHS and OSAHS in patients with OSAHS and the effect of the operation on the level of leptin in the patients with OSAHS, with a view to the epidemic investigation and surgical effect of OSAHS.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R766
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