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目的探讨肥胖或超重OSAS患者食管裂孔疝的发生和食管功能的改变。方法回顾性分析2015年3月至2016年4月,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196名肥胖或超重打鼾患者的临床资料,对其进行常规肺功能、脉冲震荡、肺容积测定、夜间睡眠监测、食管测压和24 h食管测酸,根据睡眠监测结果分为OSAS组(病例组)和非OSAS组(对照组),比较2组食管裂孔疝的发生情况并肺容积和呼吸力学改变对食管功能的影响。结果病例组和对照组性别、年龄、体重、BMI、肺通气功能和肺容积相同的情况下,合并OSAS组患者的食管裂孔疝发生率(61.3%)明显高于对照组,差异有统计学意义(P<0.001)。功能残气量与吸呼气压力差绝对值呈负相关(P=0.01),补呼气量与食管上括约肌静息压呈正相关(P=0.04)。坐位Zat5ZH和坐位Rcentral肺弹性阻力与吸呼气压力差绝对值呈正相关(P<0.05);坐位Rperipheral肺弹性阻力与吸呼气压力差绝对值呈正相关(P<0.001),与食管上括约肌静息压呈负相关(P=0.04);卧位Zat5HZ和卧位Rperipheral肺弹性阻力与食管下括约肌静息压呈负相关(P<0.001),与吸呼气压力差绝对值、食管裂孔疝的发生呈正相关(P<0.001);卧位Rcentral肺弹性阻力与吸呼气压力差绝对值、胃食管压力差、食管裂孔疝的发生相关性呈正相关,与食管下括约肌静息压和远端收缩延迟相关性呈负相关(P<0.05)。结论肥胖或超重患者合并OSAS是导致EHH的的重要因素之一,并且肥胖或超重打鼾患者尤其合并OSAS者肺容积的减少和弹性阻力的增高对食管功能的影响较大,可能与肥胖或超重OSAS患者变大的胸腔负压波动和肺弹性阻力的增加有关。
Objective To investigate the changes of esophageal hiatal hernia and esophageal hernia in obese or overweight OSAS patients. Methods From March 2015 to April 2016, the clinical data of 196 obese or overweight snore patients hospitalized with minimally invasive hernia and abdominal wall surgery in People’s Hospital of Xinjiang Uygur Autonomous Region from March 2015 to April 2016 were retrospectively analyzed. Their pulmonary function, pulse shock, lung Volume measurement, nighttime sleep monitoring, esophageal manometry and 24 h esophageal acid test were divided into OSAS group (case group) and non-OSAS group (control group) according to sleep monitoring results. The incidence of esophageal hiatal hernia in two groups was compared and lung volume And changes in respiratory mechanics on esophageal function. Results The incidence of hiatal hernia in the OSAS group (61.3%) was significantly higher than that in the control group with the same gender, age, body weight, BMI, pulmonary ventilation and lung volume in the case and control groups, the difference was statistically significant (P <0.001). There was a negative correlation between functional residual capacity and absolute absolute value of suction pressure (P = 0.01). The volume of fill-up ventilation was positively correlated with resting pressure of upper esophageal sphincter (P = 0.04). There was a positive correlation between the absolute value of airway resistance and the absolute value of airway pressure difference between sitting Zat5ZH and sitting Rcentral (P <0.05). There was a positive correlation between the Rperipheral pulmonary elastic resistance and the absolute value of suctioning air pressure difference (P <0.001) (P = 0.04). There was a negative correlation between pulmonary elastic resistance of Zat5HZ in supine position and Rperipheral supine hypothalamic sphincter resting pressure (P <0.001), absolute value of pressure difference with suctioning breath, hiatal hernia of esophageal hiatal hernia (P <0.001). There was a positive correlation between Rcentral pulmonary elastic resistance and the absolute values of suction pressure, gastroesophageal pressure difference and hiatal hiatal hernia in the supine position, which were related to the resting pressure and distal contraction of the lower esophageal sphincter Delayed correlation was negatively correlated (P <0.05). Conclusions OSAS with obesity or overweight is one of the most important factors leading to EHH. And the decrease of lung volume and the increase of elastic resistance in obese or overweight snore patients, especially those with OSAS, have a greater influence on esophageal function, which may be related to obesity or overweight OSAS Patients with larger thorax negative pressure fluctuations and increased pulmonary elastic resistance.