【作者】 陈懿宇；

【导师】 汪卫东；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2008， 硕士

【摘要】 目的通过对痰湿证睡眠呼吸暂停患者运用持续正压通气治疗后,得到呼吸机压力水平,用相关的原始数据得出压力值计算公式,方便临床应用。方法将2007年3月至2008年3月广安门医院睡眠门诊的患者通过痰湿证诊断和PSG的筛查,得到的54例痰湿型睡眠呼吸暂停低通气患者,于次夜行呼吸机压力滴定,将得到的数据采用SPSS13.0软件进行统计分析,得出与平均压力相关的多元线性回归方程,及和平均压力有关的95%有效压力值(即实际最大压力),用于临床压力值调定,同时与目前临床上较有争议的Hoffstein公式进行对比,发现所测的平均压力值与之较为接近。结果1.在54例痰湿证患者中,重度OSAHS患者占68.51%,重度低氧血症患者占75.93%,重度肥胖占51.85%。最低血氧、鼾声指数和AHI显著相关(P<0.01),年龄和AHI相关(p<0.05).2.CPAP治疗前后AHI指数有显著差异(P<0.01),CPAP治疗前后鼾声指数有显著差异。CPAP治疗疗效显著。3.最高压力、最低压力、95%有效压力值和Hoffestein方程压力值差异显著(P<0.01),平均压力值和Hoffstein公式压力值无明显差异(P>0.05)。4.BMI、颈围、最低血氧、AHI、鼾声指数均和平均压力直线相关( P<0.01)5.根据多元线性逐步回归,得出颈围、AHI、鼾声指数均有统计学意义,回归方程为平均压力=0.220×颈围+0.036×AHI+0.001×鼾声指数—3.7466.根据直线回归,得出95%有效压力值运算公式95%有效压力值=5.393+0.690×平均压力结论1.本次研究筛选了54例痰湿证睡眠呼吸暂停低通气患者,发现睡眠呼吸暂停低通气者以重度肥胖的中青年男性患者居多,多为重度睡眠呼吸暂停低通气综合征及重度夜间低氧血症。2.呼吸暂停低通气指数和最低血氧、年龄、鼾声指数相关。提示患者对平时的鼾声要引起足够重视。尤其是肥胖的中青年打鼾患者更易患此病。3.呼吸机对OSAHS患者疗效显著,压力滴定前后患者的呼吸暂停低通气指数和鼾声指数明显下降,提示呼吸机治疗后疗效理想,患者病情明显好转。4. BMI、颈围、最低血氧、AHI、鼾声指数均与CPAP平均压力显著相关,在知道患者颈围,AHI指数,鼾声指数的前提下,可通过回归方程计算得出所需平均压力,并根据此压力值推出95%有效压力(实际最大压力)。5.OSAHS治疗前景广阔,除呼吸机治疗外,可加入中药治疗,以提高患者的依从性,使对OSAHS患者有新的选则。更多还原

【Abstract】 The research on Phlegm damp OSAHS patients’proper Pressure level with continuous positive airway pressureObject: Treat the Phlegm damp OSAHS patients with continuous positive airway pressure.Get a related calculation formula from these data, which can be used in the clinic practice.Method:To get 54 cases of Phlegm damp OSAHS patients from the sleep-department of Guang’anmen hospital from March, 2007 to March, 2008. The patients were diagnosed with PSG and Phlegm damp criteria. Then in the second night, we treated the patients with continuous positive airway pressure, and form a multivariate linear regression equation which can be used to calculate the pressure level( average pressure) with related data. Compare all kinds of pressure levels to the Hoffstein pressure level, and found that there is no significant difference between average pressure in our study and Hoffstein pressure level. All the statistics are analyzed by software SPSS13.0.Result:1. In 54 phlegm-damped OSAHS cases, severe OSAHS patients are about 68.51%, and severe nocturnal hypoxemia are 75.93%, severe obesity are 51.85%. Lowest oxygen, snore index are significantly correlated with AHI(p<0.01), and age are correlated with AHI(p<0.05).2. There is significant difference between the AHI before and after the treatment of continuous airway pressure (p<0.01), and the snore index is also differ greatly before and after the treatment of CPAP. The effect of this treatment is significant.3. The highest pressure, lowest pressure, and 95% effective pressure differ significantly to the pressure calculated by Hoffstein equation (p<0.01), however, there is no greatly difference between average pressure and Hoffstein pressure (p>0.05). 4. BMI, neck circumference, the lowest oxygen, AHI and snore index are correlated to average pressure (p <0.01).5. According to multivariate linear regression equation, we found that neck circumference, AHI, snore index are statistical significant.multivariate linear regression equation is as follows:average pressure of CPAP=0.220*neck circumference +0.036*AHI+0.001*snore index-3.746 95%effective pressure of CPAP= 5.393+0.690*average pressureConclusion: 1.This research selected 54 phlegm-damped OSAHS patients, and it is found out that the severe obesity of middle aged male take the major part, and most of them are severe OSAHS and severe nocturnal hypoxemia syndrome.2. AHI are significant correlated with the lowest oxygen, age, snore index, which indicated that we shall pay more attention to the snore. And the overweight middle aged men may have OSAHS easily than others.3. CPAP is effective to OSAHS patients, AHI and snore index decreased dramatically with the treatment of the CPAP.4. BMI, neck circumference, the lowest oxygen, and snore index significant correlate to average pressure, we can get the average pressure level by the multivariate linear regression equation.5. The treatments of OSAHS may vary from CPAP to traditional medicine, and the use of TCM might increase patients’compliance, and become the new choice for patients.更多还原