老年OSAHS患者PCI后夜间心绞痛的临床分析  

Clinical analysis of nocturnal angina in senile patients with OSAHS after PCI

作　　者：黄志坚[1] 韩烨[1] 汪玫[1] 陈吉[2] 张淑静[2] 

机构地区：[1]解放军44医院心内科,贵阳550009 [2]解放军44医院呼吸内科,贵阳550009

出　　处：《西南国防医药》2015年第4期358-360,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的分析老年冠心病合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者,经皮冠状动脉介入（PCI）治疗后数月,出现夜间睡眠心绞痛的原因。方法12例老年OSAHS患者,PCI前有劳力性心绞痛,但无夜间心绞痛,PCI数月后出现夜间心绞痛。收集该12例患者PCI前后的冠脉Gensini积分、睡眠呼吸暂停低通气指数（AHI）、夜间最低氧饱和度（miniSaO2）、体位相关呼吸事件等数据进行分析比较。结果本组12例PCI术后3~6个月出现夜间心绞痛。出现夜间心绞痛后即入院复查冠脉造影或CT,并行Gensini冠脉评分,与PCI时的冠脉Gensini积分比较无差异（P〉0.05）,PCI数月后冠脉病变无进展。PCI后AHI高于PCI术前（P〈0.01）,且夜间miniSaO2较术前降低（P〈0.05）。PCI数月后夜间仰卧、右侧卧位阻塞性及低通气事件均较术前增加（P〈0.05）,提示AHI的升高、OSAHS的加重与仰卧及右侧体位睡姿阻塞性事件增加有关。结论部分PCI术前无夜间心绞痛的老年冠心病OSAHS患者,PCI术后因避免左侧卧位而改变睡姿,夜间睡眠中以仰卧及右侧卧位为主,左侧卧位减少,特别是仰卧位更易出现睡眠呼吸暂停,使AHI增高,miniSaO2降低,OSAHS加重,成为PCI术后夜间心绞痛发生的原因之一。Objective To analyze the causes to nocturnal angina in senile patients with coronary heart disease （CHD） and obstructive sleep apnea-hypopnea syndrome （OSAHS） several months later from percutaneous coronary intervention （PCI）. Methods The research subjects included 12 patients with OSAHS. Before PCI, they suffered from exertional angina but there was not nocturnal angina; several months later from PCI, nocturnal angina occurred. In them, their Gensini scores of coronary artery, sleep apnea hypopnea index （AHI）, the lowest nocturnal SaO2 （miniSaO2 ）, and position related respiratory events before and after PCI were collected in order to make comparison and analysis. Results Nocturnal angina occurred in all 12 patients in 3-6 months after the PCI. Once the nocturnal angina occurred, the patients were sent to the hospital for angiography or CT, and Gensini scores of coronary artery were made, which had no significant differences from those during PCI （ P 〉 0.05 ） ; several months later from PCI, the coronary lesion had no development. After PCI, AHI increased （P 〈0.01 ） and miniSaO2 decreased （P 〈0.05）. Several months later from PCI, low ventilation and obstructive events in supine and right postures at night increased compared with the preoperative time （ P 〈 0.05 ） , and this suggested that the increase of AHI and OSAHS were correlated with obstructive events in supine and right postures. Conclusion Some senile patients with CHD and OSAHS but without nocturnal angina before PCI, mainly sleep in supine and right postures but not left posture, and this is easy to cause sleep apnea as well as AHI inerease and miniSaO2 decrease, and OSAHS gets more serious accordingly, becoming one of the causes to nocturnal angina after PCI.

关 键 词：老年 冠心病 冠状动脉介入 夜间 心绞痛 阻塞性睡眠呼吸暂停低通气综合征 

分 类 号：R541.4[医药卫生—心血管疾病]