PCI对OSAHS患者呼吸调控稳定性的影响  

Effects of Percutaneous Coronary Intervention on the Stability of Respiratory Regulation in OSAHS Patients

作　　者：赵晓赟[1] 赵芳[1] 张力[1] 李冠华[1] 李月川[1] 

机构地区：[1]天津市胸科医院胸内科,300051

出　　处：《天津医药》2013年第5期441-444,共4页Tianjin Medical Journal

摘　　要：目的研究冠心病经皮冠状动脉介入治疗(PCI)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者呼吸调控稳定性的影响。方法按就诊时间顺序选取经多导睡眠监测(PSG)确诊为OSAHS(呼吸暂停低通气指数AHI≥5),但未接受持续气道正压(CPAP)通气或手术治疗的冠心病患者41例,采用病例自身对照法分别在PCI术前、术后3d、术后1个月进行PSG、血清学及超声心动图检查,收集相关临床资料并进行比较。结果患者的血清学检验、超声心动图检查等临床资料在PCI术后3d及1个月与术前相比较差异均无统计学意义。而中枢性睡眠呼吸暂停指数(CSAI)、混合性睡眠呼吸暂停指数(MSAI)和微觉醒指数(MAI)在PCI术后3d较术前显著升高(P<0.01),术后1个月较术后3d又显著下降(P<0.01),与术前水平相比差异无统计学意义。结论冠心病PCI可能引起OSAHS患者短暂性的呼吸调控功能不稳定和交感神经兴奋性增高,表现为患者在睡眠时中枢性睡眠呼吸暂停(CSA)、混合性睡眠呼吸暂停(MSA)、微觉醒事件一过性增加,但具有自限性。Objective To investigate whether pereutaneous coronary intervention（PCI）causes instability of the respi- ratory regulation in patients of coronary heart disease with obstructive sleep apnea-hypopnea syndrome （OSAHS）. Meth- ods A prospective self-control study was conducted in 41 patients suffered OSAHS with the apnea-hypopnea index （AHI）≥ 5. These patients （with coronary heart disease） were diagnosed as OSAHS by polysomnography （PSG） and did not receive con- tinuous positive airway pressure （CPAP） ventilation or surgical treatment . The polysomnograph, echoeardiogram and serum test were performed before PCI, 3-day, and 1-month after PCI respectively. The relevant clinical data were collected for com- parison. Results There were no significant differences in echocardiogram and serological test of patients between before PCI and 3-day and 1-month after PCI （P 〉 0.05）. The central sleep apnea index （CSAI）, the mixed sleep apnea index （MSAI） and the micro-arousal index （MAI） were significantly increased 3-day after PCI than those before operation （P 〈 0.01）. There were a significantly decreases in CSAI, MSAI and MAI l-month after PCI than those of 3-day after PCI （P 〈 0.01）. Conclu- sion PCI may provoke transient instability of central respiratory regulation, and increase sympathetic activity, which showed a transient increase in central sleep apnea （CSA）, mixed sleep apnea （MSA） and micro-arousal events during sleep periods.

关 键 词：血管成形术 经腔 经皮冠状动脉 睡眠呼吸暂停 中枢性 睡眠呼吸暂停 阻塞性 呼吸中枢 心肌再灌注损伤 内皮细胞 

分 类 号：R473.6[医药卫生—护理学]