上海交通大学学报(医学版) ›› 2019, Vol. 39 ›› Issue (12): 1437-.doi: 10.3969/j.issn.1674-8115.2019.12.016

• 论著·临床研究 • 上一篇    下一篇

阻塞性睡眠呼吸暂停低通气综合征患儿血压与儿茶酚胺水平的关系研究

陈淑梅,吴佳欐,李晓艳   

  1. 上海市儿童医院 上海交通大学附属儿童医院耳鼻咽喉头颈外科,上海200062
  • 出版日期:2019-12-28 发布日期:2020-02-06
  • 通讯作者: 李晓艳,电子信箱:chhshent@163.com。
  • 作者简介:陈淑梅(1981—),女,主治医师,硕士;电子信箱:han5528@126.com。

Correlation between blood pressure and level of catecholamine in children with obstructive sleep apnea hypopnea syndrome

CHEN Shu-mei, WU Jia-li, LI Xiao-yan   

  1. Department of Otolaryngology-Head and Neck Surgery, Childrens Hospital of Shanghai, Childrens Hospital of Shanghai Jiao Tong University, Shanghai 200062, China
  • Online:2019-12-28 Published:2020-02-06

摘要: 目的·分析不同程度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患儿血压同血浆中儿茶酚胺水平的关系。方法·回顾性分析2014 年1月—12月于上海市儿童医院耳鼻咽喉头颈外科就诊行手术治疗的以睡眠打鼾为主诉的2~12岁患儿病例资料,行整夜多导睡眠图(polysomnography,PSG)监测并测量清醒状态下的收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)。依据 2010年中国儿童青少年血压参照标准,将OSAHS患儿分为血压正常组、SBP升高组、DBP升高组、SBP和DBP均升高组。将OSAHS患儿根据PSG监测中的呼吸暂停低通气指数(apnea hypopnea index,AHI)和最低血氧饱和度(lowest oxygen saturation, LSpO2)分为轻度组、中度组和重度组,分析不同程度的OSAHS患儿血压与血浆儿茶酚胺水平的关系。结果·共223例研究对象纳入分析,SBP为(100.3±9.8) mmHg(1 mmHg0.133 kPa),DBP为(63.0±9.8) mmHg;符合高血压诊断者50例(22.42%),其中严重高血压20例(8.97%)。OSAHS患儿轻、中、重度组分别为59、127、37例。血压正常组与DBP升高组之间血浆肾上腺素水平的差异有统计学意义(P0.032);DBP升高组与SBP和DBP均升高组之间LSpO2的差异有统计学意义(P0.031);4组间多巴胺及去甲肾上腺素水平差异无统计学意义。OSAHS轻度组与中度组之间SBP及肾上腺素水平的差异具有统计学意义(P0.038,P0.000),中度组与重度组之间的差异则无统计学意义;多巴胺及去甲肾上腺素水平在3组之间比较,差异均无统计学意义。结论·OSAHS患儿血浆中儿茶酚胺水平的升高可导致SBP上升,并随着病情加重而升高,因而对OSAHS患儿应该尽早诊断及治疗。

关键词: 阻塞性睡眠呼吸暂停低通气综合征, 儿童, 高血压, 儿茶酚胺

Abstract: Objective · To investigate the correlation between blood pressure and catecholamine levels in children with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods · January 2014 to December 2014, children and adolescents aged 2 to 12 years old who complained mainly of snoring during sleep were admitted to Department of Otolaryngology-Head and Neck Surgery, Shanghai Childrens Hospital and underwent surgery. All-night polysomnography (PSG) was used to monitor and measure the systolic blood pressure (SBP) and diastolic blood pressure (DBP) in conscious state. According to the blood pressure reference standard of Chinese children and adolescents in 2010, the children with OSAHS were divided into normal blood pressure group, SBP increased group, DBP increased group, and SBP and DBP increased group. The children with OSAHS were divided into light, moderate and severe OSAHS subgroups according to the apnea hypopnea index (AHI) and the lowest oxygen saturation (LSpO2). The correlation between blood pressure and the level of catecholamine was analyzed in the children with OSAHS. Results · Two hundred and twenty-three subjects were included in the analysis. The average SBP was (100.3±9.8) mmHg (1 mmHg0.133 kPa) and the average DBP was (63.0±9.8) mmHg. There were 50 cases (22.42%) diagnosed as hypertension, in which 20 cases (8.97%) were severe hypertension. The 223 children with OSAHS were divided into mild OSAHS subgroup (n59), moderate OSAHS subgroup (n127) and severe OSAHS subgroup (n37) according to OSAHS grades. The difference of adrenaline level between the normal blood pressure group and the DBP increased group was statistically significant (P0.032). The difference of LSpO2 between the DBP increased group and the SBP and DBP increased group was statistically significant (P0.031). There were no significant differences in dopamine and noradrenaline levels among the four groups. There were significant differences in SBP and adrenaline level between OSAHS mild subgroup and moderate subgroup (P0.038, P0.000), but there were no significant differences between the moderate OSAHS subgroup and the severe OSAHS subgroup. There were no significant differences in dopamine and noradrenaline levels among the three OSAHS subgroups. Conclusion · The increase of plasma catecholamine level in children with OSAHS can lead to the increase of SBP, which will increase with the development of OSAHS. Therefore, early diagnosis and treatment of OSAHS should be taken into consideration.

Key words: obstructive sleep apnea hypopnea syndrome (OSAHS), children, hypertension, catecholamine