【作者】 李晓含；

【导师】 李玉红；

【作者基本信息】 青海大学 ， 内科学（呼吸系病）（专业学位）， 2023， 硕士

【摘要】 目的:通过比较不同海拔下肥胖性低通气综合征（OHS）患者睡眠紊乱与肺动脉压力的变化,探讨高海拔低氧环境对OHS患者肺动脉压力的升高有无影响,从而进一步预防肺动脉高压的形成,提高人们对高海拔OHS合并肺动脉高压的早期识别及管理,延缓肺动脉高压的发展,减少慢性高原病的发生。方法:选择2020年10月-2023年3月于青海地区综合医院就诊的高海拔地区（海拔>2500m）OHS患者及健康成人各20例作为观察组,选择同期在低海拔地区（海拔<500m）与观察组年龄、性别相仿的OHS患者及健康成人各20例。收集各组患者PSG监测数据及心脏彩超相关指标,并分析高、低海拔OHS患者平均氧饱、夜间最低血氧饱和度（Sp O₂）、Sp O₂<90%的时间、Pa CO₂与肺动脉收缩压的关系。结果:1、高海拔OHS组的夜间最低Sp O₂、平均氧饱水平、N3期时间低于低海拔OHS组（P<0.05）,N1期、Sp O₂<90%的时间占比高于低海拔OHS组（P<0.05）差异具有统计学意义;两组AI、HI、REM期、NREM期、N2期无统计学差异（P>0.05）。低海拔OHS组的平均氧饱水平、REM期低于低海拔健康组（P<0.05）,Sp O₂<90%的时间、N1期、AI、HI均高于低海拔健康组（P<0.05）,差异具有统计学意义;两组N2、N3期、NREM期、夜间最低Sp O₂均无统计学差异（P>0.05）。高海拔OHS组的AI、HI、Sp O₂<90%的时间、N1期均高于与高海拔健康组（P<0.05）,N3期、平均氧饱、夜间最低Sp O₂均低于高海拔健康组（P<0.05）,差异具有统计学意义;两组的REM期、NREM、N2期无统计学差异（P>0.05）。四组TST均无统计学意义（P>0.05）。2、高海拔OHS患者的肺动脉收缩压、主肺动脉内径均高于低海拔OHS组（P<0.05）,差异具有统计学意义;高海拔OHS组的肺动脉收缩压高于高海拔健康组（P<0.05）,差异具有统计学意义;低海拔OHS组肺动脉收缩压高于低海拔健康组（P<0.05）,差异具有统计学意义;四组的右室前后径、右室左右径、右室流出道均无统计学差异（P>0.05）;3、高海拔OHS组患者的平均氧饱、夜间最低Sp O₂与肺动脉收缩压呈负相关（P<0.05）;Sp O₂<90%的时间、Pa CO₂与肺动脉收缩压呈正相关（P<0.05）;低海拔OHS组患者的平均氧饱、夜间最低Sp O₂与肺动脉收缩压呈负相关（P<0.05）;Sp O₂<90%、Pa CO₂的时间与肺动脉收缩压呈正相关（P<0.05）。结论:1、低海拔OHS组的N1期睡眠时间较低海拔健康组延长,且N3期睡眠时间较低海拔健康组缩短,提示OHS可引起睡眠结构的紊乱;2、高海拔OHS组肺动脉收缩压的水平高于低海拔OHS组,提示OHS可能引起肺动脉压的升高,且OHS患者在高海拔环境的影响下,病情比低海拔地区更加严重;3、高、低海拔OHS患者的Sp O₂<90%的时间、Pa CO₂与肺动脉收缩压呈正相关,平均氧饱、夜间最低Sp O₂与肺动脉收缩压呈负相关,提示低氧的时间越长、高碳酸血症越重,肺动脉收缩压越高,对评估OHS合并PH疾病的病情严重程度及预后有一定的临床意义。更多还原

【Abstract】 Objective:By comparing the changes of sleep disturbance and pulmonary artery pressure in patients with obesity hypoventilation syndrome（OHS）at different altitudes,to investigate whether the high-altitude hypoxic environment has any effect on the elevation of pulmonary artery pressure in OHS patients,so as to further prevent the formation of pulmonary hypertension,improve the early recognition and management of combined pulmonary hypertension in high-altitude OHS,delay the development of pulmonary hypertension,and thus reduce the chronic The study aims to improve the early recognition and management of high-altitude OHS combined with pulmonary hypertension,delay the development of pulmonary hypertension,and thus reduce the occurrence of chronic altitude disease.Methods:Twenty patients with OHS at high altitude（altitude>2500m）and healthy adults each attending tertiary hospitals in Qinghai region from October 2020 to March2023 were selected as the observation group,and 20 patients with OHS at low altitude（altitude<500m）with similar age and gender as the observation group and healthy adults each during the same period were selected.The PSG monitoring and cardiac ultrasound related indexes were collected from each group,and the relationship between the mean oxygen saturation,the lowest nighttime oxygen saturation（Sp O₂）,the time of Sp O₂<90%,apnea index（AI）,hypoventilation index（HI）,apnea hypoventilation index（AHI）,oxygen decompensation index（ODI）and pulmonary artery systolic pressure in patients with OHS at high and low altitudes were analyzed.Results:1.The minimum nighttime Sp O₂,mean oxygen satiation level,and time of N3 period in the high-altitude OHS group were lower than those in the low-altitude OHS group（P<0.05）,and the percentage of time of N1 period and Sp O₂<90%were higher than those in the low-altitude OHS group（P<0.05）The differences were statistically significant;there were no statistical differences between the two groups in AI,HI,REM period,NREM period,and N2 period（P>0.05）.The mean oxygen satiety level and REM period of the low altitude OHS group were lower than those of the low altitude healthy group（P<0.05）,and the time of Sp O₂<90%,N1 period,AI,and HI were higher than those of the low altitude healthy group（P<0.05）,and the differences were statistically significant;there were no statistical differences between the two groups in N2,N3 period,NREM period,and lowest Sp O₂ at night（P>0.05）.The AI,HI,time to Sp O₂<90%,and N1 period were all higher in the high-altitude OHS group than those in the high-altitude healthy group（P<0.05）,and the N3 period,mean oxygen satiation,and nighttime minimum Sp O₂ were all lower than those in the high-altitude healthy group（P<0.05）,and the differences were statistically significant;the REM period,NREM,and N2 period were not statistically different between the two groups（P>0.05）.TST was not statistically significant in any of the four groups（P>0.05）.2 The pulmonary artery systolic pressure and main pulmonary artery internal diameter were higher in the high-altitude OHS patients than in the low-altitude OHS group（P<0.05）,and the differences were statistically significant;the pulmonary artery systolic pressure in the high-altitude OHS group was higher than in the high-altitude healthy group（P<0.05）,and the differences were statistically significant;the pulmonary artery systolic pressure in the low-altitude OHS group was higher than in the The differences were statistically significant;the right ventricular anterior-posterior diameter,right ventricular left and right ventricular right and right ventricular outflow tracts of the four groups were not statistically different（P>0.05）;3.The mean oxygen saturation,the lowest nighttime Sp O₂ and pulmonary artery systolic pressure of patients in the high-altitude OHS group were negatively correlated（P<0.05）;the time of Sp O₂<90%,Pa CO ₂ and pulmonary artery systolic pressure was positively correlated with pulmonary artery systolic pressure（P<0.05）;mean oxygen saturation and nighttime minimum Sp O₂ were negatively correlated with pulmonary artery systolic pressure in patients in the low altitude OHS group（P<0.05）;time with Sp O₂<90%and Pa CO₂were positively correlated with pulmonary artery systolic pressure（P<0.05）。Conclusions:1.the duration of N1 stage sleep was prolonged in the low altitude OHS group compared with the low altitude healthy group,and the duration of N3 stage sleep was shortened compared with the low altitude healthy group,suggesting that OHS may cause disorder of sleep structure;2.the level of pulmonary artery systolic pressure in the high-altitude OHS group was higher than that in the low-altitude OHS group,suggesting that OHS may cause the elevation of pulmonary artery pressure,and the condition of OHS patients under the influence of high-altitude environment was more serious than that in the low-altitude area;3.the time of Sp O₂<90%,Pa CO₂ and pulmonary artery systolic pressure in patients with high and low altitude OHS were positively correlated,and the mean oxygen saturation and the lowest Sp O₂at night were negatively correlated with pulmonary artery systolic pressure,suggesting that the longer the time of hypoxia and the more severe the hypercapnia,the higher the pulmonary artery systolic pressure,It has clinical significance in assessing the severity and prognosis of OHS combined with PH disease.更多还原