喉及下咽部恶性肿瘤患者并发阻塞性睡眠呼吸暂停综合征的相关因素分析

发布时间：2018-03-19 19:23

  本文选题：阻塞性睡眠呼吸暂停低通气综合征　切入点：喉部及下咽部恶性肿瘤　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的阻塞性睡眠呼吸暂停综合征(Obstructive Sleep Apnea Syndrome,OSAS)是一种临床常见的疾病,遗传因素、解剖因素、神经体液因素、肥胖及其他多种因素均是该病的常见病因。OSAS可引起心脑血管、内分泌等多种系统的严重并发症,使患者的生活质量有所下降,甚至危及生命。OSAS目前已被认为是多种全身性疾病的独立危险因素。研究已证实OSAS可以促进肿瘤的发生与发展,并且与头颈部肿瘤存在一定的关系。喉癌及下咽癌是常见的头颈部恶性肿瘤,同时也是耳鼻咽喉科中发病率较高的恶性肿瘤。据报道,喉部及下咽部恶性肿瘤患者多数也存在夜间睡眠障碍、白天嗜睡等症状。合并OSAS的头颈部肿瘤患者术后并发症较高。而经过治疗后患者体内的多种肿瘤相关基因的表达均有所下降。由此可见OSAS的有效治疗对于肿瘤的预防和治疗有一定的意义。因此该类患者是否合并OSAS应尽早得到诊断与治疗,从而降低其在肿瘤的发生和发展中的作用,减少肿瘤治疗的并发症。该研究旨在探讨OSAS与喉部及下咽部恶性肿瘤的相关关系,为临床的诊疗工作提供一定的指导意义。方法对2016年2月至9月间至郑州大学第一附属医院耳鼻咽喉头颈外科就诊的50例术后病理最终确诊为喉部或下咽部恶性肿瘤的患者,使用便携式睡眠监测仪进行夜间睡眠监测,监测患者的睡眠呼吸暂停低通气指数(Apnea Hypopnea Index,AHI)、平均血氧饱和度(Mean Oxygen Saturation)以及最低血氧饱和度(the Lowest Oxygen Saturation)等数据。AHI≥5次/h即可诊断为OSAS。根据AHI的大小将患者分为非OSAS组与OSAS组,比较两组患者在年龄、性别、身高体重指数(Body Mass Index,BMI)、肿瘤部位及肿瘤分期等方面是否存在差异。以有无OSAS为因变量,以年龄、性别、BMI、肿瘤部位及肿瘤分期为自变量建立Logistic回归方程,分析喉部及下咽部恶性肿瘤相关性OSAS的危险因素。结果按照OSAS的诊断标准,本研究中的50例喉部及下咽部恶性肿瘤患者中有43例患者可诊断为OSAS,即患病率约为86%。其平均AHI为(15.81±11.87)次/h,平均平均血氧饱和度为(92.52±5.10)%,平均最低血氧饱和度为(72.80±10.78)%。OSAS组与非OSAS组患者在性别、BMI、肿瘤部位、肿瘤分期等方面均无统计学差异(P0.05),Logistic回归分析显示年龄是喉部及下咽部恶性肿瘤相关OSAS的危险因素。结论喉部及下咽部恶性肿瘤患者中OSAS的患病率较高,年龄是其相关危险因素,而该类患者中OSAS的患病率与患者的BMI、肿瘤部位及其分期无明显关系。
[Abstract]:Background & objective obstructive Sleep Apnea syndromes (OSAs) is a common clinical disease. Genetic factors, anatomical factors, neurohumoral factors, obesity and many other factors are the common causes of the disease. OSAS may cause cardiovascular and cerebrovascular diseases. The serious complications of many systems, such as endocrine, have reduced the quality of life of patients, and even life-threatening. OSAS has been considered to be an independent risk factor for many systemic diseases. Studies have proved that OSAS can promote the occurrence and development of tumors. Laryngeal carcinoma and hypopharyngeal carcinoma are common malignant tumors of head and neck, and they are also the most common malignant tumors in the department of otorhinolaryngology. Most patients with malignant tumors of larynx and hypopharynx also have nocturnal sleep disorders. Symptoms such as daytime somnolence. Head and neck tumor patients with OSAS have higher postoperative complications. After treatment, the expression of various tumor-related genes in patients has decreased. It can be seen that the effective treatment of OSAS for tumor. Prevention and treatment are of certain significance. Therefore, the diagnosis and treatment of OSAS should be obtained as soon as possible. The purpose of this study was to investigate the relationship between OSAS and laryngeal and hypopharyngeal malignancies. Methods from February 2016 to September, 50 patients with malignant tumor of larynx or hypopharynx were treated in Department of Otorhinolaryngology head and neck surgery, the first affiliated Hospital of Zhengzhou University, from February 2016 to September. Use portable sleep monitor to monitor sleep at night, The data of apnea Hypopnea index, mean Oxygen saturation and Lowest Oxygen saturation. AHI 鈮，

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