经鼻持续气道正压通气治疗阻塞性睡眠呼吸暂停低通气综合征合并左心室收缩功能不全  

Nasal continuous positive airway pressure in treatment of obstructive sleep apnea/hypopnea syndrome with left ventricular systolic dysfunction.

作　　者：林其昌[1] 丁海波[1] 王春娥[1] 黄鸿波[1] 陈公平[1] 师广斌[1] 陈华[1] 赵建铭[1] 

机构地区：[1]福建医科大学附属第一医院呼吸内科,福州350005

出　　处：《中国综合临床》2006年第7期595-598,共4页Clinical Medicine of China

基　　金：福建省科技厅资助课题(98-Z-163)

摘　　要：目的初步探讨经鼻持续气道正压通气(nCPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并左心室收缩功能不全患者的疗效和机制。方法21例OSAHS合并左心室收缩功能不全患者随机分为2组,治疗组在原药物治疗基础上用nCPAP治疗,对照组继续原药物治疗,3个月后行多导睡眠检测,超声测量左心室收缩末和舒张末内径,放射性核素心血池显影测量左心室射血分数,并测定血浆内皮素,测量血压,观察其变化。结果治疗组患者整夜睡眠监测中呼吸暂停低通气指数(AHI)、最低脉搏血氧饱和度(SpO2Low)、平均呼吸暂停时间、一整夜睡眠监测中脉搏血氧饱和度低于90%时间占整个睡眠监测时间的百分比(TST-SpO2<90%)、TST-SpO2<80%均明显改善(P<0.01),血浆内皮素、夜间平均心率和平均收缩压较治疗前明显降低(均P<0.05),左心室收缩末内径较治疗前缩短(P<0.05)、左心室射血分数提高(P<0.01)。结论nCPAP治疗可以消除呼吸暂停,纠正低氧血症,明显降低血浆内皮素含量,降低夜间平均心率和平均收缩压,改善左心室收缩功能。Objective To observe the effect and mechanism of nasal continuous positive airway pressure （nCPAP） in the treatment of obstructive sleep apnea/hypopnea syndrome （OSAHS） with left ventricular systolic dysfunction. Methods The twenty-one OSAHS patients with left ventricular systolic dysfunction were randomly divided into two groups. The treatment group was treated by nCPAP on the basis of former medicine but the control group was treated by former methods. Three months later, polysomnography （ PSG ）, echocardiography and gated radionuclide angiography were performed for the determination of left ventricular end-systolic and diastolic dimension and left ventriculer enjection fraction（ LVEF）. The plasma endothelin was measured. Results After three months＇ nCPAP therapy in OSAHS with left ventficular systolic dysfunction,the AHI,overnight minimum SpO2 （% ） ,Mean apnea duration ,% TST-SpO2 〈 90% and % TST-SpO2 〈 80% were significantly improved （ P 〈 0.01 ）, nocturnal mean heart rate and mean systolic blood pressure were significantly decreased, the left vcntricular ejection fraction increased significantly（ P 〈 0.01 ） followed by left ventricular end-systolic dimension and plasma endothelin（P 〈 0. 05 ） Conclusion nCPAP may abolish sleep apnea and hypopnea, correct hypoxemia, obviously reduce the plasma endothelin level, reduce the nocturnal mean heart rate and systolic blood pressure, and improve left ventricular systolic function.

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 持续气道正压通气 左心室收缩功能不全 

分 类 号：R56[医药卫生—呼吸系统]