脉冲震荡仪在呼吸暂停综合征不同体位中的临床研究.doc

脉冲震荡仪在呼吸暂停综合征不同体位中的临床研究 童国强 熊小明 罗于琳 付云杰 摘要 目的：探讨睡眠呼吸暂停低通气综合征（Obstructive sleep apnea syndrome,0SAHS），在坐位、侧卧位、仰卧位时 ，脉冲强迫震荡检测（Impulse oscilometry system ,IOS）的各种不同呼吸阻抗，与0SAHS诊断的相关性，试图提供一个临床简单、便捷的诊断检测手段。方法：江西省九江市第一人民医院门诊、住院部疑似0SAHS 患者82例，使用电子计算机VAX-Ⅱ,用数学方法，对其不同体位的各种脉冲呼吸阻抗等，进行与临床诊断相关的多因素逐步回归分析。结果：发现受影响主要因素与顺序排列，依次为：仰卧位的上气道阻力R35、中心气道阻力R20、呼吸总阻抗Zrs、外周气道阻力R5及中心总阻Rc。结论：仰卧位 的IOS检查，可以直接、无创、快捷地测定OSAHS诸多气道阻抗参数，它为无睡眠状态下，诊断OSAHS的方法，提供了可接受的敏感性和特异性。 关键词 睡眠呼吸暂停低通气综合征 脉冲强迫震荡 多因素逐步回归分析 [Abstract] Objective To investigate the relationship between the respiratory impedance of Obstructive sleep apnea syndrome(OSAHS) were measured by using of Impulse oscilometry system (IOS) in the sitting position，lateral position and supine position and the diagnosis for 0SAHS; try to provid a clinical simple convenient diagnosis method. Method 82 individuals who were selected were referred for suspected OSAHS in out-patient clinic or admission department of Jiujiang 1st people hospital; the relationship between the respirator impedance of different positions and clinical diagnosis for OSAHS was evaluated using the multiple factor gradual regressive analysis which utilized mathematics approach by the computer VAX-Ⅱ;Results According to its important sequence ，the main factors which contributed to diagnosis in turns were upper airway resistance(R35)；centerat airway resistance(R20) , total impedance(Zrs), peripheral airways(R5), and centerat airway impedance(Rc) in supine position. Conclusions with IOS measurements in supine position, the respiratory impedance of OSAHS might have been directly,noninvasively, quickly obtained;and this measurements might provid the acceptable sensitivity and specificity of the diagnosis for 0SAHS in no-sleep condition. key words: Obstructive sleep apnea syndrome Impulse oscilometry system multiple factor gradual regressive analysis 1 资料和方法 1.1 资料 九江市第一人民医院，2008年10月——2011年8月，呼吸内科门诊、住院部OSAHS 疑似病例82例，男性51例，女性31例，最小年龄42岁，最大81岁，平均61.8±12.7岁。对照组