气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者脉压的影响  

Effect of the treatment of continuous positive airway pressure on pulse pressure in patients of obstructive sleep apnea hypopnea syndrome

作　　者：夏晓东[1] 刘道候[1] 李继武[2] 林洁[1] 吴成云[1] 冯玲丽[1] 

机构地区：[1]温州医学院附属第二医院呼吸内科,325072 [2]浙江省温州医学院附属第二医院心内科,325072

出　　处：《临床肺科杂志》2008年第1期49-51,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者脉压的变化及经鼻持续气道正压通气(nCPAP)的影响。方法选择85例经多导睡眠图仪(PSG)诊断的OSAHS患者,同时随机选取15例中重度OSAHS患者进行nCPAP治疗,在PSG监测前后及期间每2小时测量其血压,计算出脉压、脉压变化幅度、平均收缩压及平均舒张压,并计算体重指数。结果41%OSAHS患者同时合并有高血压;OSAHS合并高血压组患者的呼吸紊乱指数、脉压及体重指数明显高于单纯OSAHS患者,其最低血氧饱和度以及平均血氧饱和度均低于单纯OSAHS患者;重度OSAHS患者的脉压、体重指数、平均收缩压及平均舒张压均明显大于轻、中度OSAHS患者,而轻、中OSAHS患者之间差异无显著性意义。nCPAP可提高OSAHS患者最低血氧饱和度,同时降低其呼吸紊乱指数、平均收缩压、平均舒张压及脉压。相关分析结果表明,呼吸紊乱指数与脉压(r=0.395,P<0.01)、平均收缩压(r=0.403,P<0.01)、平均舒张压(r=0.313,P<0.01)呈正相关,与最低氧饱和度(r=-0.424,P<0.01)呈负相关,与体重指数、平均氧饱和度无相关。结论脉压是OSAHS的严重程度及是否并发高血压心血管事件的预测因子;nCPAP能下调OSAHS患者脉压及血压,是缓解OSAHS病情进展的有效治疗措施。Objective To investigate the effect of nasal continuous positive airway pressure （nCPAP） on the changes of pulse pressure in patients of obstructive sleep apnea-hypopnea syndrome （OSAHS） with or without hypertension. Methods 85 case of OSAHS accompanied by hypertension or not were examined by polysomnography and blood pressure monitor apparatus, 15 of which were treated by nCPAP for moderate and severe patients of OSAHS. Pulse pressure, mean systolic and diastolic blood pressure and body index were calculated. Results Hypertension was accompanied in 41% patients of OSAHS. The apnea hypopnea index （AHI） , body index and pulse pressure in patients of OSAHS accompanied by hypertension was higher than that in normotensive OSAHS, but the minimum and the mean value of saturation of oxygen from skin （ SpO2 ） in patients of OSAHS accompanied by hypertension were lower than that in normotensive OSAHS. Pulse pressure, body index, mean systolic and diastolic blood pressure were higher, but the minimum and the mean value of SpO2 lower in severe patients of OSAHS than those in mild and moderate patients of OSAHS. There was no significant difference between mild and moderate patients of OSAHS. Pulse pressure, body index, mean systolic and diastolic blood pressure decreased after the treatment of nCPAP, meanwhile the minimum and the mean value of SpO2 increased in moderate and severe patients of OSAHS. There were positive correlations between AHI and pulse pressure, variety of pulse pressure, mean systolic and diastolic blood pressure. There was negative correlation between AHI and the minimum value of SpO2. And there were no correlations between AHI and body mass index, and the mean value of SpO2. Conclusion It is indicated that pulse pressure were important cardiovascular event predicator, which were associated with serious degree and complication of hypertension in patients of OSAHS. nCPAP therapy can clown-regulate blood pressure and pulse pressure, which is effective in relieving the deterioration of OSHAS.

关 键 词：阻塞性睡眠呼吸暂停综合征 高血压 脉压 呼吸紊乱指数 气道正压通气 

分 类 号：R56[医药卫生—呼吸系统] R544.1[医药卫生—内科学]