经胸超声心动图冠状动脉血流成像技术评价阻塞性睡眠呼吸暂停综合征患者冠状动脉血流储备的价值  

Assessment of coronary flow reserve using transthoracic echocardiography in patients with obstructive sleep apnea hypopnea syndrome

作　　者：张玉萍[1] 张莉[1] 马春梅[2] 肖晓刚[1] 任华[1] 崔美月[1] 

机构地区：[1]中国航天科工集团公司七三一医院超声影像科,北京100143 [2]武警总医院健康医学中心,北京100039

出　　处：《中华医学超声杂志（电子版）》2015年第6期438-445,共8页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：首都医学发展科研基金(2009-3220)

摘　　要：目的探讨经胸超声心动图冠状动脉血流成像技术评估阻塞性睡眠呼吸暂停综合征(OSA)患者冠状动脉血流储备(CFR)的价值。方法选择2010年3月至2013年12月航天七三一医院收治的OSA患者50例。其中5≤呼吸暂停低通气指数(AHI)<20,18例;20≤AHI<40,16例;AHI>40,16例。采用经胸超声心动图冠状动脉血流成像技术检测静息状态下冠状动脉左前降支远端舒张期最大峰值血流速度(PDV)、舒张期平均血流速度(MDV)及注射三磷酸腺苷(ATP)后PDV、MDV及CFR。选择40名健康体检者作为健康对照组。采用t检验比较OSA患者与健康对照组PDV、MDV、CFR差异;采用单因素方差分析比较不同AHI的OSA患者PDV、MDV、CFR差异,进一步组间两两比较采用SNK-q检验;采用t检验比较OSA患者、健康对照组、不同AHI的OSA患者静息状态下与ATP负荷状态下PDV、MDV差异。结果静息状态下,全部受检者均获得满意的冠状动脉左前降支远端血流及多普勒频谱。静脉注射ATP后,健康对照组PDV、MDV分别为(92.78±7.68)、(85.93±6.98)cm/s,高于静息状态下的(28.09±4.55)、(21.76±5.09)cm/s,且差异均有统计学意义(t值分别为49.687、58.259,均P<0.001);静脉注射ATP后,OSA患者PDV、MDV分别为(82.73±6.91)、(77.39±6.73)cm/s,高于静息状态下的(29.93±3.66)、(22.28±4.15)cm/s,且差异均有统计学意义(t值分别为55.381、47.700,均P<0.001)。静息状态下,OSA患者与健康对照组PDV、MDV差异均无统计学意义;静脉注射ATP后,OSA患者PDV、MDV均高于健康对照组,且差异均有统计学意义(t值分别为6.524、5.884,均P<0.01)。静息状态下,不同AHI的OSA患者PDV、MDV差异均无统计学意义;静脉注射ATP后,不同AHI的OSA患者PDV、MDV均较静息状态下增加,且差异均有统计学意义(5≤AHI<20:t值分别为-32.903、-32.771,均P=0.000;20≤AHI<40:t值分别为-37.122、-32.623,均P=0.000;AHI>40:t值分别为-28.197、-20.184,均P=0.000);且AHI>40的OSA患者PDV、MDV均�Objective To estimate the value of transthoracic coronary flow Doppler imaging to detect coronary flow reserve（CFR） changes in patient with obstructive sleep apnea syndrome（OSA）. Methods Fifty patients with OSA who hospitalized or were outpatient in Aerospace 731 Hospital during the period of 2010 March to 2013 December were enrolled in this study and were divided into three groups according to apnea hypopnea index（AHI）. Eighteen cases of patients which AHI was greater than 5 and less than 20 were defined as mild group, 16 cases of patients which AHI was more than 20 and less than 40 were defined as middle group, 16 cases of patients which AHI was greater than 40 were defined as severe group. The diastolic peak velocity（PDV） and mean flow velocity（MDV） of the distance segment of left anterior descending coronary（LAD） were measured by transthoracic echocardiography at rest and after intravenous infusion of adenosine triphosphate（ATP）. Meanwhile, CFR was calculated. Forty healthy persons were chosen as control group. The t test was used to compare the difference of PDV, MDV and CFR between OSA group and healthy controls. The single factor analysis of variance was used to compare the difference of PDV, MDV and CFR in patients with different AHI. SNK- q test was used to compare in different OSA groups. The ttest was used to compare the difference of PDV, MDV among OSA group, healthy control and OSA groups with different AHI at rest and after intravenous infusion of ATP. Results Coronary flow velocity Doppler signals were successfully obtained in all the groups. PDV（[92.78±7.68] cm/s） and MDV（[85.93±6.98] cm/s） after intravenous infusion of ATP in control group were significant higher than those at rest（[28.09±4.55] cm/s and [21.76±5.09] cm/s）（t=49.687 and 58.259, both P〈0.001）. PDV（[82.73±6.91] cm/s） and MDV（[77.39±6.73] cm/s） after intravenous infusion of ATP in OSA group were significant higher than those at rest（[29.93±3.66] cm/s and [22.28±4.15] cm/s

关 键 词：超声心动图 阻塞性睡眠呼吸暂停综合征 冠状动脉血流储备 

分 类 号：R540.45[医药卫生—心血管疾病] R766[医药卫生—内科学]