nCPAP 对中重度阻塞性睡眠呼吸暂停低通气综合征患者心肌供血的影响  

Estimate the Effects of nCPAP Treatment to the Myocardial Blood-supply in Patients with Moderate-severe Obstructive Sleep Apnea-Hypopnea Syndrome

作　　者：朱云云[1] 潘伟民[2] 沈旭平[3] 傅卜年[4] 黄依琴[4] 郭永娟[5] 李东波[5] 

机构地区：[1]浙江省宁波市第一医院老年科,315010 [2]浙江省宁波市第一医院心内科,315010 [3]宁波大学医学院 [4]浙江省宁波市第一医院睡眠监测室,315010 [5]浙江省宁波市第一医院心电图室,315010

出　　处：《心电与循环》2012年第4期234-238,共5页Journal of Electrocardiology and Circulation

摘　　要：目的 观察中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与心肌供血的关系,探讨经鼻持续气道内正压通气（nCPAP）治疗对中重度OSAHS患者心肌供血的影响.方法 将明确诊断为中重度OSAHS患者中随机分为持续nCPAP治疗1年以上的长期治疗组（n=32 例）,短期治疗组（n=30 例）及对照组（n=31 例）.治疗前三组的临床基本特征差异无统计学意义（P＞0.05）.分别对治疗后的三组患者进行24h动态心电图和睡眠呼吸监测,观察呼吸睡眠暂停-低通气事件、心肌缺血负荷,同时实时观察呼吸暂停-低通气事件和血氧饱和度下降与心肌缺血的关系.结果 对照组中13 例（41.94%）夜间出现心肌缺血发作,心肌缺血负荷为（59.12±7.18）mm·min / h.其与呼吸暂停- 低通气累计持续时间及累计次数呈正相关（r=0.816、0.749,P＜0.01）.随着血氧饱和度下降幅度增加,心肌缺血发作次数也增多,差异有显著统计学意义（P＜0.01）.长期治疗组患者经1年的nCPAP 治疗后夜间心肌缺血发生例数（6.25%、41.94%）及心肌缺血负荷[（1.32±0.78）mm·min / h、（59.12±17.18）mm·min / h],与对照组相比均明显减少,差异有显著统计学意义（P＜0.01）,与短期治疗组比较差异无明显统计学意义（P＞0.05）.在短期组中,仅3 例（10.00%）夜间出现心肌缺血发作,心肌缺血负荷为（2.42±1.43）mm·min / h,与对照组比较,心肌缺血程度减少,差异有显著统计学意义（P＜0.01）.结论 夜间心肌缺血在中重度OSAHS患者中较多见,且与呼吸暂停- 低通气持续时间、发生次数及血氧饱和度下降幅度有关.无论长期还是短期的nCPAP 治疗都能明显减少中重度OSAHS 患者夜间心肌缺血的发生例数.Objective To investigate the moderate-severe OSAHS in relation to myocardial blood-supply,and explore the effects of nasal continuous positive airway pressure on these patients. Methods We recruited moderate-severe OSAHS from January 2009 to May 2011, and randomly selected 32 as long-term nCPAP therapy group （A group）, which accepted more than 1 year nCPAP therapy,30 patients with untreated group（B group）,31 who accepted to 1day nC- PAP therapy as short-term treatment group （C group）.Everyone use an overnight sleep study and Holter recording to examine disordered breathing,ST segment depression.Real time observation of sleep disordered breathing events duration and frequency of occurrence with ST segment depression. Results In the control group,there were 13 patients（41.94%） occurred myocardial ischemic in the night,the ischemic burden during sleep was（59.12 ± 7.18）mm· min / h.The relation between myocardial ischemic and sleep apnea-hypopnea ,with total duration time and total frequency,was positive in moderate-severe OSAHS （r=0.816,P〈0.001 ;r=0.749,P〈0.05）.The occurrence of myocardial ischemic also followed with the oxygen desaturation （P〈0.01）.ln long-term nCPAP therapy group,there were only2 patients （6.25%）occurred myocardial ischemic in the night,the ischemic burden during sleep was（1.32 ± 0.78）mm-min/h.Compared with the control group,which had significantly decreased（P〈0.01）. In short-term nCPAP therapy group,there were only3patients（10.00%）occurred my- ocardial ischemic in the night.the ischemic burden during sleep was （2.42 ± 1.43）mm-min/h.Compared with the controlgroup,which had significantly reduced （P〈0.01）.There was no significant statistical difference between the short-time therapy group and the control group. Conclusion Nocturnal myocardial ischemia was common in patients with moderate-severe OSAHS,which may relate with apnea-hypopnea and oxygen desaturation. No matter long-term therapy or short-term therapy ,nCPAP can significantly

关 键 词：阻塞睡眠呼吸暂停 经鼻持续气道正压通气 心肌缺血负荷 

分 类 号：R766.43[医药卫生—耳鼻咽喉科]