超重或肥胖患者胃食管反流病对睡眠呼吸暂停综合征的影响研究  

Effect of gastroesophageal reflux disease on obstructive sleep apnea syndrome in overweight or obese patients

作　　者：卡哈尔·吐尔逊 再努尔·语苏普 买买提吐尔逊·吐尔迪[1] 唐荣华 阿地力江·阿力甫 吴源泉[1] 艾克拜尔·艾力[4] 克力木·阿不都热依木[4] Kahaer·Tuerxun;Zainuer·Yusufu;Maimaitituerxun·Tuerdi;Tang Ronghua;Adilijiang·Alifu;Wu yuanquan;Aikebaier·Aili;Kelimu·Abudoureyimu(Department of Second general surgery,People's first hospital of kashi,kashi 844000,China;Ultrasound Department,People's first hospital of kashi,kashi 844000,China;Pharmacy department,People's first hospital of kashi,kashi 844000,China;Department of Minimal Invasive and Hernia,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]喀什地区第一人民医院普外二科,844000 [2]喀什地区第一人民医院超生医学科,844000 [3]喀什地区第一人民医院药学部,844000 [4]新疆维吾尔自治区人民医院微创、疝和腹部外科,乌鲁木齐830001

出　　处：《中华胃食管反流病电子杂志》2021年第2期65-70,共6页Chinese Journal Of Gastroesophageal Reflux Disease(Electronic Edition)

基　　金：喀什地区第一人民医院院级项目基金(KDYY201806);喀什地区第一人民医院朝阳人才项目。

摘　　要：目的探讨超重或肥胖胃食管反流病(GERD)患者中阻塞性睡眠呼吸暂停综合征的发生及其潜在的机制。方法分析2018年09月至2020年06月在新疆维吾尔自治区人民医院微创疝和腹壁外科就诊住院的125名肥胖或超重打鼾患者的临床资料,对其进行食管24 h pH值监测、常规肺功能、脉冲震荡、夜间睡眠监测、食管测压,根据食管24 h pH值监测分为胃食管反流病组(病例组)和胃食管反流病组(对照组),比较2组阻塞性睡眠呼吸暂停综合征(OSAS)的发生、呼吸力学特征和食管功能的变化及食管酸反流及食管功能学指标与睡眠呼吸紊乱指数(AHI)的相关性。结果病例组和对照组性别、年龄、民族、体质量和体质量指数(BMI)等混杂因素在2组分布相同的情况下,病例组睡眠呼吸暂停综合征发生率(93%),对照组发生率(30%),明显高于对照组,差异有统计学意义(P<0.001)。坐位状态下病例组气道总弹性阻力、中心气道和周围气道阻力及5~35 HZ脉冲震荡阻力下气道弹性阻力明显高于对照组(P<0.05),气道电阻抗两组无明显统计学差异(P>0.05),卧位状态下病例组气道总弹性阻力、中心气道及周围气道弹性阻力及5~35 HZ脉冲震荡阻力下气道弹性阻力及电阻抗明显高于对照组(P<0.001)。病例组胃食管压力差、食管裂孔大小明显大于对照组,食管下括约肌压力、远端收缩积分明显小于对照组,差异有统计学意义(P<0.05),病例组食管上括约肌压力、食管下括约肌长度小于对照组,远端收缩延迟时间大于对照组,但差异无统计学意义(P>0.05)。Demeester评分、食管近端反流百分比、食管裂孔大小、胃食管压力差与AHI成正相关(r>0,P<0.05),远端收缩延迟、吸呼气压力差与AHI成负相关(r<0,P<0.05)。结论超重或肥胖患者中胃食管反流病是加重或诱发阻塞性睡眠呼吸暂停综合征的重要危险因素之一,胃食管反流病患者食管酸反流及食�Objective Investigate the occurrence of obstructive sleep apnea syndrome(OSAS)and its mechanism in overwheit or obese Gastroesophageal reflux disease(GERD)patients.Methods To 125 overweight or obese patients Since september 2018 to june 2020 in the people's Hospital of Xinjiang Uyghur Autonomous Region underwent 24 hours esophageal acid test,routine pulmonary function,impulse oscillation,sleep monitoring and esophageal manometry.According to 24 hours esophageal acid test results divided into two groups as GERD(case group)and non-GERD(control group),to compare the incidence of OSAS in two groups and the effect of the respiratory mechanical properties,esophageal function and analyze the correlation between esophageal reflux related indexes,esophageal functional indexes and sleep disordered index(AHI).Results Under the factors of sex,age,nationality,weight and body mass indax(BMI)are same in the two groups,incidence of OSAS in case group was significantly higher than that in control group(P<0.001).In sitting position,total elastic resistance of airway,central,Peripheral airway resistance and resistance of impulse oscillation in 5~35 Hzin case group were significantly higher than those in the control group(P<0.05),There was no significant difference in the airway reactance between two groups under impulse oscillation in 5~35 Hz(P>0.05).In supine position,total elastic resistance of airway,central,Peripheral airway resistance,elastic resistance and reactance under impulse oscillation in 5~35 Hz of case group were significantly higher than those in the control group(P<0.05).The difference of gastroesophageal pressure and the size of esophageal hiatus in the case group was significantly higher than that in the control group(P<0.05).The pressure of lower esophageal sphincter and the score of distal contraction in the case group were significantly lower than those in the control group(P<0.05),the pressure of upper esophageal sphincter and the length of the lower esophageal sphincter in the case group were lower than those

关 键 词：胃食管反流病 睡眠呼吸暂停综合征 肥胖 超重 

分 类 号：R571[医药卫生—消化系统] R766[医药卫生—内科学]