切换至 "中华医学电子期刊资源库"

中华胃食管反流病电子杂志 ›› 2020, Vol. 07 ›› Issue (03) : 167 -171. doi: 10.3877/cma.j.issn.2095-8765.2020.03.007

所属专题: 文献

论著

肥胖阻塞型睡眠呼吸暂停综合征患者肺功能、酸反流及食管动力学特点分析
祖里培亚·艾拜都拉1, 苟安栓2, 买买提·依斯热依力1, 凌敏2, 艾克拜尔·艾力1, 牛灵2, 克力木·阿不都热依木3,()   
  1. 1. 微创外科
    2. 830001 乌鲁木齐,新疆维吾尔自治区人民医院呼吸与危重症医学中心
  • 收稿日期:2019-12-20 出版日期:2020-08-15
  • 通信作者: 克力木·阿不都热依木
  • 基金资助:
    新疆维吾尔自治区自然科学基金(2018D01C134)

Analysis of pulmonary function, acid reflux and esophageal dynamics in obese with obstructive sleep apnea syndrome patients

Zulipeiya·Abaidula1, Anshuan Gou2, Maimaiti·Yisireyili1, Min Ling2, Aikebaier·Aili1, Ling Niu2, Kelimu·Abudureyimu3,()   

  1. 1. Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autunomous Region,Urumqi 830001, China.
    2. Department of Respiratory and Critical Care Medicine
    3. Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autunomous Region, Urumqi 830001, China.
  • Received:2019-12-20 Published:2020-08-15
  • Corresponding author: Kelimu·Abudureyimu
引用本文:

祖里培亚·艾拜都拉, 苟安栓, 买买提·依斯热依力, 凌敏, 艾克拜尔·艾力, 牛灵, 克力木·阿不都热依木. 肥胖阻塞型睡眠呼吸暂停综合征患者肺功能、酸反流及食管动力学特点分析[J/OL]. 中华胃食管反流病电子杂志, 2020, 07(03): 167-171.

Zulipeiya·Abaidula, Anshuan Gou, Maimaiti·Yisireyili, Min Ling, Aikebaier·Aili, Ling Niu, Kelimu·Abudureyimu. Analysis of pulmonary function, acid reflux and esophageal dynamics in obese with obstructive sleep apnea syndrome patients[J/OL]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2020, 07(03): 167-171.

目的

探讨肥胖合并阻塞型睡眠呼吸暂停综合征(OSAS)患者的肺功能、酸反流以及食管动力学特征。

方法

回顾性分析2019年3月至2019年12月于新疆维吾尔自治区人民医院呼吸与危重症医学中心住院治疗的82例肥胖患者的临床资料。经多导睡眠监测(PSG)确诊并符合OSAS诊断标准的患者,进一部分为OSAS组(n=42例)和非OSAS组(n=40例)。收集患者的肺功能,GERD问卷调查,24 h pH检测以及食管动力学检测结果,分析各因素在OSAS发生中的特点。

结果

经PSG分析发现,OSAS组呼吸暂停低通气指数高于非OSAS组,其最低动脉血氧饱和度(SaO2%)低于非OSAS组,差异具有统计学意义(t=1.979,1.853;P<0.05)。OSAS组用力肺活量(FVC)和第一秒用力呼气容积(FEV1)显著低于非OSAS组,而功能残气量(FRC)明显高于非OSAS组,差异均具有统计学意义(t=2.012,1.964,1.883;P<0.05)。OSAS组睡眠障碍者显著高于非OSAS组,且差异具有统计学意义(F=5.628,P<0.05);24 h食管pH检测显示,OSAS组酸反流次数、总酸反流次数及DeMeester评分均显著高于非OSAS组,差异具有统计学意义(t=3.157,4.102,5.213;P<0.05)。OSAS组LES静息压力低于非OSAS组;UES静息压力高于非OSAS组,差异具有统计学意义(t=2.114,1.915;P<0.05)。

结论

肥胖患者中OSAS与肺功能改变、酸反流及食管动力异常有关,三者互为促进,相互影响。

Objective

To investigate the pulmonary function, acid reflux and esophageal dynamics in obese patients with obstructive sleep apnea syndrome (OSAS).

Methods

A retrospective analysis was made of 82 obese patients who were hospitalized in the respiratory and critical care medical center in our hospital from March 2019 to December 2019. According to the clinical data, the patients who were diagnosed by PSG and met the diagnostic criteria of OSAS were included in the OSAS group (n=42 case) and non OSAS group (n=42 case). The characteristics of OSAS were analyzed by lung function, GERD questionnaire, 24-hour pH test and esophageal dynamics test.

Results

The PSG analysis showed that the AHI index of OSAS group was higher than non OSAS group, and SaO2% were lower than non OSAS group (P<0.05); FVC and FEV1 in OSAS group were significantly lower than those in non OSAS group, while FRC was significantly higher than those in non OSAS group (P<0.05); sleep disorders in OSAS group were significantly higher than OSAS group (P<0.05); 24-hour esophageal pH test showed that the number of acid reflux, total acid reflux and DeMeester score in the OSAS group were significantly higher than those in the non OSAS group (P<0.05); the esophageal motility test showed that the LES resting pressure in the OSAS group was lower, and the UES resting pressure was higher than that in the non OSAS group (P<0.05).

Conclusion

OSAS in obese patients is related to the change of pulmonary function, acid reflux and esophageal motility, which can promote and influence each other.

表1 两组患者一般情况比较
表2 两组肺功能指标的比较(
xˉ
±s
表3 两组GERD症状评分比较(n%)
表4 两组24 h pH检测指标比较(
xˉ
±s
表5 两组食管动力学指标的比较(
xˉ
±s,mmHg)
1
Koo CY, Chua AP, Kristanto W, et al. Screening and treatment of obstructive sleep apnea in acute coronary syndrome. A randomized clinical trial[J]. Int J Cardiol, 2020, 299: 20-25.
2
Jönsson L, Dellenmark-Blom M, Enoksson O, et al. Long-Term Effectiveness of Antireflux Surgery in Esophageal Atresia Patients[J]. Eur J Pediatr Surg, 2019, 29(6): 521-527.
3
魏嘉洁,矫杰,周迎生,等. 阻塞性睡眠呼吸暂停低通气综合征与代谢综合征的相关性研究[J]. 心肺血管病杂志,2019,38(8):838-842.
4
Li M, Li X, Lu Y. Obstructive Sleep Apnea Syndrome and Metabolic Diseases[J]. Endocrinology, 2018, 159(7): 2670-2675.
5
Basoglu OK, Vardar R, Tasbakan MS, et al. Obstructive sleep apnea syndrome and gastroesophageal reflux disease: the importance of obesity and gender[J]. Sleep Breath, 2015, 19(2): 585-92.
6
曲伸. 2016美国临床内分泌医师学会肥胖治疗指南的解析和探讨[J]. 中华内分泌代谢杂志,2017,33(3):190-193.
7
王玮.《阻塞性睡眠呼吸暂停综合征治疗临床指南》(2013)解读[J]. 中国实用内科杂志,2014,34(2):174-176.
8
中国医师协会外科医师分会胃食管反流病专业委员会. 胃食管反流病外科诊疗共识(2019版)[J/CD]. 中华胃食管反流病电子杂志,2019,6(1):3-9.
9
阿孜古丽·买合买提,艾力根·阿不都热依木,米日古丽·吾木哈斯木,等. OSA患者的呼吸力学特征及血清肺泡表面活性物质水平与其胃食管反流事件的关系研究[J/CD]. 中华胃食管反流病电子杂志,2018,5(1):1-6.
10
Li N, Wang J, Wang D, et al. Correlation of sleep microstructure with daytime sleepiness and cognitive function in young and middle-aged adults with obstructive sleep apnea syndrome[J]. Eur Arch Otorhinolaryngol, 2019, 276(12): 3525-3532.
11
Qu Y, Ye JY, Zheng L, et al. Correlation between obstructive sleep apnea hypop nea syndrome and gastroesophageal reflux disease[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2012, 47(11): 899-903.
12
吕芳芳,贺永军,庞艳玲,等. 阻塞性睡眠呼吸暂停综合征与胃食管反流病相关性研究[J]. 现代消化及介入诊疗,2017,22(3):349-350.
13
Iannella G, Vicini C, Colizza A, et al. Aging effect on sleepiness and apneas severity in patients with obstructive sleep apnea syndrome: a meta-analysis study[J]. Eur Arch Otorhinolaryngol, 2019, 276(12): 3549-3556.
14
Schoch OD, Baty F, Boesch M, et al. Telemedicine for Continuous Positive Airway Pressure in Sleep Apnea. A Randomized, Controlled Study[J]. Ann Am Thorac Soc, 2019, 16(12): 1550-1557.
15
Yamaguchi Y, Shiota S, Kusunoki Y, et al. Polysomnographic features of low arousal threshold in overlap syndrome involving obstructive sleep apnea and chronic obstructive pulmonary disease[J].Sleep Breath, 2019, 23 (4): 1095-1100.
16
张玉沛,张劲,艾力根·阿不都热依木. OSAHS患者呼吸系统力学特征与胃食管反流相关性的研究[J/CD]. 中华胃食管反流病电子杂志,2016,3(2);24-29.
17
Kuribayashi S, Kusano M, Kawamura O, et al. Mechanism of gastroesophageal reflux in patients with obstructive sleep apnea syndrome[J]. Neurogastroenterol Motil, 2010, 22(6): 611-e172.
18
张玉沛,张劲,马子龙. OSAHS患者肺功能与胃食管反流病相关性的研究[J]. 医药前沿,2017,7(12):92-94.
19
麦麦提艾力·麦麦提明,艾克拜尔,闫海,等. 肥胖患者睡眠呼吸暂停综合征与胃食管反流病相关性研究[J/CD]. 中华胃食管反流病电子杂志,2018,5(3):23-26.
20
Sacco O, Silvestri M, Ghezzi M, et al. Airway inflammation and injury in children with prevalent weakly acidic gastroesophageal refluxes[J]. Respir Med, 2018 10, 143: 42-47.
21
陈美玲,熊鹰,曾理,等. 胃食管反流病合并高危阻塞性睡眠呼吸暂停综合征的人群特征分析[J]. 中华内科杂志,2018,57(11);824-829.
22
Wu S, Chen S, Zhao Y, et al. Association Between Excessive Daytime Sleepiness and Functional Gastrointestinal Disorders: A Population-based Study in China[J]. J Neurogastroenterol Motil, 2017, 23(2): 298-305.
[1] 向韵, 卢游, 杨凡. 全氟及多氟烷基化合物暴露与儿童肥胖症相关性研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 569-574.
[2] 陈嘉婷, 杜美君, 石冰, 黄汉尧. 母体系统性疾病对新生儿唇腭裂发生的影响[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(04): 262-268.
[3] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[4] 孟令凯, 李大勇, 王宁, 王桂明, 张炳南, 李若彤, 潘立峰. 袖状胃切除术对肥胖伴2型糖尿病大鼠的作用及机制研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 638-642.
[5] 李猛, 姜腊, 董磊, 吴情, 贾犇黎. 腹腔镜胃袖状切除术治疗肥胖合并2型糖尿病及脂肪胰的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 554-557.
[6] 玉素江·图荪托合提, 韩琦, 麦麦提艾力·麦麦提明, 黄旭东, 王浩, 克力木·阿不都热依木, 艾克拜尔·艾力. 腹腔镜袖状胃切除或联合食管裂孔疝修补术对肥胖症合并胃食管反流病的中期疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 501-506.
[7] 沈琪乐, 赵勤华, 宫素岗, 刘锦铭, 王岚, 邱宏玲. COPD 稳定期患者血清CC16 蛋白表达与肺功能、肺气肿表型的关系分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 690-695.
[8] 杨莎莎, 张毛为, 孙宜田, 刘亚南, 位娟, 魏建, 陈碧. 结缔组织疾病相关间质性肺病并发小气道功能障碍临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 738-743.
[9] 郭璟琪, 魏明言, 刘芳, 李冬凌, 关金平, 李立华. 乙酰半胱氨酸治疗慢性阻塞性肺疾病急性加重期的疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 768-772.
[10] 刘雯, 赵明栋, 夏伟, 潘以雄. 不同剂量比阿培南治疗重症肺炎的疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 789-792.
[11] 刘见, 杨晓波, 何均健, 等. 应用电钩三孔法腹腔镜袖状胃切除术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(06): 363-364.
[12] 谢浩文, 丁建英, 刘小霞, 冯毅, 姚婧. 椎旁神经阻滞对微创胃切除肥胖患者术中血流、术后应激及康复质量的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 569-573.
[13] 闫维, 张二明, 张克, 安欣华, 向平超. 北京市石景山区40岁及以上居民早期慢性阻塞性肺疾病异质性及影响因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 533-540.
[14] 王星, 陈园, 热孜万古丽·乌斯曼, 郭艳英. T2DM、Obesity、NASH、PCOS共同致病因素相关的分子机制[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 481-490.
[15] 中国医师协会外科医师分会肥胖代谢病综合管理与护理专家工作组, 中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国肥胖代谢外科研究协作组. 肥胖代谢外科医学科普中国专家共识(2024 版)[J/OL]. 中华肥胖与代谢病电子杂志, 2024, 10(04): 227-234.
阅读次数
全文


摘要