慢性舒张性心力衰竭合并睡眠呼吸紊乱的观察  

Sleep disordered breathing with chronic diastolic heart failure

作　　者：耿立霞[1] 吴彦[2] 陈琦玲[3] 孙利[4] 

机构地区：[1]内蒙古科技大学第一附属医院ICU,包头014010 [2]北京大学人民医院心内科 [3]北京大学人民医院高血压病房 [4]包头包钢第三职工医院

出　　处：《中华临床医师杂志（电子版）》2007年第3期20-23,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的观察慢性舒张性心力衰竭患者睡眠呼吸紊乱(SDB)发生情况。方法对舒张性心力衰竭患者(现有或既往曾有充血性心力衰竭症状、超声心动图射血分数≥45%且E/A<1)应用便携式睡眠监测仪Embletta进行睡眠监测,根据呼吸紊乱指数(AHI)将患者分为SDB组(AHI>10次/h)和非SDB组(AHI≤10次/h),观察两组睡眠期间AHI与血氧饱和度(SO2)(平均SO2、最低SO2和SO2<90%)和心率(最低心率、最高心率和最大心率变化)的关系。结果共观察36例患者,其中15例(41.7%)表现出AHI>10次/h而分为SDB组,其余21例为非SDB组。两组AHI分别为(24.5±15.0)次/h和(4.6±2.7)次/h,睡眠中最低SO2分别为(78.9±8.7)%和(86.7±3.4)%(P<0.05)。AHI与SO2<90%占总记录时间百分比、最低SO2相关(r=0.615和r=-0.626,P<0.01)。SDB组和非SDB组发生严重心动过缓(心室率≤40次/min)分别为80.0%(12/15)和28.6%(6/21)(P<0.05)。两组最低心率分别为(36.8±7.0)次/min和(43.7±5.6)次/min,并与AHI、SO2<90%时间呈负相关(r=-0.489和r=-0.515),与最低SO2呈正相关(r=0.559)(P均<0.05)。两组最大心率变化分别为(51.8±19.5)次/min和(40.7±9.7)次/min,并与AHI、SO2<90%的时间呈正相关(r=0.537和r=0.319),与最低SO2、平均SO2呈负相关(r=-0.428和r=-0.344)(P均<0.05)。结论慢性舒张性心力衰竭合并SDB的患病率很高且伴发严重夜间低氧血症,并可导致患者夜间出现严重心动过缓。Objective To determine the prevalence of sleep disordered breathing （SDB） with stable chronic diastolic heart failure. Methods Diastolic heart failure （echocardiogram LVEF≥45% and E/A ratio 〈 1 ,with present or previous symptoms of heart failure） patients were monitored by ambulatory diagnostic equipment＂Embletta＂. According to apnea and hypopnea index（AHI） ,patients were divided into SDB group（ AHI 〉 10/h） and non-SDB group（ AHI ≤10/h） and compare the frequence of AH1 with arterial oxyhemoglobin saturation（ SO2 ） （ mean SO2,lowest noctural SaO2, perc.entage of time with SO2 〈 90% ） and heart rate （minimum heart rate,maximum heart rate and maximum heart rate change） in these two groups. Results Thirty-six patients were recruited. Fifteen patients （41.7%） with AHI 〉 10/h was in SDB group and the other twenty-one was in non-SDB group, AHI was 24.5 ± 15.0 versus 4. 6 ± 2. 7 per hour （ P 〈 0.05） ,lowest noctural SaO2 was 78.9 ± 8.7% versus 86.7 ± 3.4% （ P 〈 0. 05 ）. There were significant correlations between AHI and percentage of time with SO2 〈90% （ r =0. 615 ） and lowest noctural SaO2 （ r = -0. 626） , （ all P 〈0. 01 ）. In SDB and non-SDB group the severe bradycardia （ heart rate ≤〈40 beats/min ） was 80% （ 12/15 ） versus 28.6% （6/21 ） （ P 〈 0. 05 ）, minimum heart rate was 36. 8 ± 7.0 versus 43.7 ± 5.6 beats/rain and was related to AHI （ r = - 0. 489 ） , to nocturnal SO2 〈 90% （ r = - 0. 515 ） and to nocturnal minimum SO2 （ r = 0. 559） （ all P 〈 0. 05 ）. Maximum heart rate change was 51.8 ± 19. 5 versus 40. 7 ± 9. 7 beats/min and was related to AHI （ r = 0. 537 ）, to nocturnal SO2 〈 90 % （ r = 0. 319 ）, to nocturnal minimum SO2 （ r = - 0. 428, ） and to mean SO2 （ r = - 0. 344 ） （ all P 〈 0. 05 ）. Conclusions Diastolic patients have high prevalence of SDB, which can cause severe nocturnal arterial oxyhemoglobin desaturation. There are significant correlations betwee

关 键 词：心力衰竭 舒张性 睡眠呼吸紊乱 血氧监测 经皮 

分 类 号：R541.6[医药卫生—心血管疾病] R766.43[医药卫生—内科学]