BiPAP对慢性心力衰竭合并睡眠呼吸暂停综合征患者的血管内皮功能及心肺功能的影响  

The Influence of BiP AP on Vascular Endothelium Function and Heart and Lung Function of Patients with Chronic Heart Failure and Obstructive Sleep Apnea

作　　者：韩秀平[1] 贺钰梅[1] 汪丽丽[1] 张永莉[1] 成涌[1] 

机构地区：[1]延安大学附属医院心脑血管病区综合内科,陕西延安716000

出　　处：《医学综述》2016年第21期4289-4291,4295,共4页Medical Recapitulate

摘　　要：目的探讨双水平式呼吸道正压(BiP AP)对慢性心力衰竭合并睡眠呼吸暂停综合征患者血管内皮功能以及心肺功能的影响。方法选取2013年10月至2014年10月延安大学附属医院收治的86例慢性心力衰竭合并睡眠呼吸暂停综合征患者为研究对象,按照随机数字表法分为常规治疗组和联合治疗组,各43例。常规治疗组采用营养支持等常规治疗,联合治疗组在此基础上给予BiP AP无创呼吸机治疗。比较两组治疗后的血管内皮功能、心肺功能的变化及临床疗效。结果治疗后,两组的血浆内皮素1、一氧化氮、凝血酶Ⅲ等血管内皮功能指标均较治疗前改善;治疗后联合治疗组动脉血二氧化碳分压低于常规治疗组[(49.6±4.3)mmH g(1 mmH g=0.133 k Pa)比(51.4±4.0)mmH g],动脉血氧分压、第一秒用力呼气量/用力肺活量、第一秒用力呼气量、最大吸气压、最大呼气压高于常规治疗组[(92.4±7.0)mmH g比(89.3±6.1)mmH g,(64.1±3.4)比(62.3±3.9),(2.3±0.2)L比(2.2±0.2)L,(112.3±16.1)cmH 2O(1 cmH 2O=0.098 k Pa)比(98.4±17.8)cmH 2O,(189.6±15.1)cmH 2O比(172.4±17.8)cmH 2O](P<0.05);联合治疗组患者的总有效率为93.0%(40/43),高于常规治疗组的69.8%(30/43)(χ2=2.051,P=0.040)。结论常规治疗联合BiP AP无创呼吸机治疗慢性心力衰竭合并睡眠呼吸暂停综合征,可改善患者缺氧情况,对患者心肺功能及血管内皮功能均有改善。Objective To study the influence of bi-level positive airway pressure （BiPAP） ventilationon on endothelial function and heart and lung function of patients with chronic heart failure and sleep apnea syn- dromes. Methods Total of 86 cases of chronic heart failure with obstructive sleep apnea admitted to Affilia- ted Hospital of Yan＇an University from Oct. 2013 to Oct. 2014 were inluded in the study, and then divided into a conventional therapy group and a combination therapy group according to the random number table methods ,43 cases in each group. The conventional therapy group received nutritional support, continuous low flow oxygen therapy, airway pateney, respiratory stimulants and other conventional anti-infection treatment. The combination therapy group was treated with BiPAP non-invasive ventilation on the basis of conventional therapy. Vascular endothelial function and cardiopulmonary function of the two groups before and after treat- ment were compared,the clinieal efficacy was compared too. Results After treatment,the vascular endothe- lin-1, nitric oxide, and thrombin -I± of the two groups were improved than before. After treatment, the carbon dioxide partial pressure of the conventional therapy group was higher than the combination therapy group L （49. 6 ±4. 3） mmHg vs （51.4 ±4. 0） mmHg] ,blood pressure,forced expiratory volume in one second/ forced vital capacity, forced expiratory one second gas volume, maximum inspiratory pressure, maximum expir- atory pressure of the conventional therapy group were lower than the combination therapy group [ （ 92.4 ± 7.0） mmHgvs （89.3±6.1） mmHg,（64.1±3.4） vs （62.3 ±3.9）,（2.3 ±0.2） Lvs （2.2 ±0.2） L, （112.3 ±16.1） emH20 vs （98.4 ±17.8） cmH20,（189. 6 ± 15. 1） cmH20 vs （172.4 ±17. 8） cmH20], the differences were statistically significant （ P 〈 0. 05 ）. The total effective rate of the combination therapy group was 93.0% （40/43）, of the conventional treatment group was 69. 8 % （30/43）, there

关 键 词：慢性心力衰竭 睡眠呼吸暂停 双水平式呼吸道正压 

分 类 号：R541[医药卫生—心血管疾病]