持续气道正压通气治疗对OSA合并冠心病的长期预后影响的研究  

Research on the effects of CPAP for OSA combined CHD long-term prognosis

作　　者：王金凤[1] 方金瑞[2] 谢宇平[1] 马薇[1] 惠培林[1] 苏晓艳[1] 郭斌[1] 刘瑜 WANG Jinfeng;FANG Jinrui;XIE Yuping;MA Wei;HUI Peiling;SU Xiaoyan;GUO Bing;LIU Yu(Sleep Medicine Center,Gansu Provincial People Hospital,Lanzhou,730000,China;Day care center,Gansu Provincial People Hospital)

机构地区：[1]甘肃省人民医院睡眠医学中心,兰州730000 [2]甘肃省人民医院日间诊疗中心

出　　处：《临床耳鼻咽喉头颈外科杂志》2019年第11期1031-1035,1039,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金(No:81560228);2018甘肃省卫生和计划生育委员会项目(No:1291);2018年甘肃省人民医院院内基金项目(No:18GSSY4-19);2016年甘肃省卫生行业科研计划项目(No:GSWSKY2016-07);2015年甘肃省重大疾病调查研究项目(No:2015-01);2019年甘肃省卫生行业科研管理项目(CPAP对OSA合并冠心病的冠脉病变及长期预后影响的研究)

摘　　要：目的:探讨持续气道正压通气治疗(CPAP)对OSA合并冠心病(CHD)长期预后影响的研究。方法:随机选取OSA合并CHD患者120例,依据AHI分为2组,A组(轻、中度OSA合并CHD)60例、B组(重度OSA组合并CHD)60例。对比分析各组PSG参数及冠脉病变程度的差异及CPAP治疗后对冠脉长期预后的影响。结果:B组较A组,AHI、BMI、低血氧饱和度(LSaO2),ESS评分,同型半胱氨酸氨酸,高血压、2型糖尿病的患病率,急性心梗、多血管病变的患病率及SYNTAX评分显著增加(P<0.05);射血分数显著降低(P<0.05);BNP及cTNT浓度2组差异无统计学意义(P>0.05)。随访(30.0±4.2)个月后,B组:CAPA+常规治疗组较单纯常规治疗组,LSaO2、射血分数显著增加(P<0.05),AHI、心血管不良事件、多血管病变、SYNTAX评分、BNP及TNT浓度显著降低(P<0.05);A组:AHI显著降低(P<0.05),LSaO2显著增加(P<0.05),射血分数、心血管不良事件、多血管病变、SYNTAX评分、BNP及TNT浓度无显著性差异;生存分析显示,A组:CPAP+常规治疗组累计生存率高于常规治疗组,但差异无统计学意义(P=0.260);B组:CPAP+常规治疗组累计生存率显著高于常规治疗组(P<0.001)。结论:随着OSA严重程度的增加,OSA合并CHD的冠脉病变程度进一步加重;CPAP治疗有利于CHD的长期预后。Objective: To investigate the effects of CPAP for obstructive sleep apnea(OSA) combined CHD(coronary heart disease) long-term prognosis. Method: One hundred and twenty cases of OSA combind CHD in gansu province people’s hospital sleep center were randomly divided into two groups according to apnea hypopnea index(AHI), group A(light, medium OSA and CHD) 60 cases, group B(severe OSA and CHD) 60 cases. Contrast analysis and comparison between two groups PSG(Polysomnography) parameters, and the differences between the degree of coronary artery lesions and CPAP therapy effect on coronary long-term prognosis. Result: Compared group B with A, AHI, BMI, LSaO2, Epworth sleepiness scale(ESS) score, the amino acid homocysteine, the prevalence of hypertension, type 2 diabetes, the prevalence of acute myocardial infarction(ami) and vascular lesions and SYNTAX score increased significantly(P<0.05). The ejection fraction decreased significantly(P<0.05). The BNP(Brain natriuretic peptide) and cTNT(cardiac troponin, cTn) concentration there was no significant difference between the two groups(P>0.05). CPAP treatment(30.0±4.2) months later, Group B: CAPA + conventional treatment group, compared with the simple routine LSaO2, ejection fraction increased significantly(P<0.05), AHI, cardiovascular adverse events, vascular lesions, SYNTAX score, the BNP and TNT concentration significantly reduced(P<0.05);Group A: AHI, decreased significantly(P<0.05), LSaO2increased significantly(P<0.05), ejection fraction, cardiovascular adverse events, vascular lesions, SYNTAX score, there was no significant difference between the BNP and TNT concentration;Survival analysis showed that: Group A CPAP+conventional treatment group cumulative survival rate higher than the conventional treatment group, but there was no statistically significant difference(P=0.260). Group B: CPAP+conventional treatment group total survival rate was significantly higher than that of the conventional treatment group(P<0.001);Conclusion: With the increase of the severity o

关 键 词：睡眠呼吸暂停低通气综合征 阻塞性 冠心病 持续气道正压通气治疗 

分 类 号：R563.8[医药卫生—呼吸系统]