持续气道正压通气对中-重度阻塞性睡眠呼吸暂停综合征合并脑血管病患者预后的影响  

The effects of continuous positive airway pressure in treatment of moderate or severe obstructive sleep apnoea syndrome complicated by cerebrovascular diseases

作　　者：石鑫[1] 台立稳[1] 刘素云[2] 张瑞宁[2] 王蕾 裴观辉 张雪 SHI Xin;TAI Liwen;LIU Suyun(Department of Neurology,The Second Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,石家庄市050000 [2]河北医科大学第二医院心血管内科,石家庄市050000 [3]河北医科大学第二医院儿科,石家庄市050000

出　　处：《河北医药》2020年第4期490-493,498,共5页Hebei Medical Journal

基　　金：河北省青年科技课题(编号:20170552)

摘　　要：目的评估持续气道正压通气(continuous positive airway pressure,CPAP)治疗合并脑血管病的中-重度阻塞性睡眠呼吸暂停综合征(obstructive sleep apnoea syndrome,OSAS)患者临床事件的长期疗效。方法选择2009年11月至2013年1月合并脑血管病的OSAS患者80例,分为试验组和对照组,每组40例。试验组患者失访2例,对照组患者失访4例。试验组(n=38)接受CPAP治疗联合药物治疗,对照组(n=36)仅接受药物治疗。比较试验组和对照组的患者心脑血管事件的发生情况。结果随访5年,试验组患者发生心脑血管事件总数9例(非致死性卒中8例,心血管死亡1例)。对照组患者发生心脑血管事件总数17例(非致死性卒中12例,致死性卒中1例,非致死性心血管病3例,心血管死亡1例)。试验组患者心脑血管事件的发生率明显低于对照组患者(23.7%比47.2%),差异有统计学意义(P<0.05)。对合并高血压的患者给予CPAP治疗后,患者血压在12个月及24个月时较初诊时差异有统计学意义(P<0.05)。结论CPAP治疗可在一定程度上降低合并脑血管病的OSAS患者心脑血管事件的发生率,降低合并高血压的OSAS患者的血压,值得临床推广。Objective To investigate the long term efficacy of continuous positive airway pressure(CPAP)in treatment of moderate or severe obstructive sleep apnoea syndrome(OSAS)complicated by cerebrovascular diseases.Methods A total of 80 patients with OSAS complicated by cerebrovascular diseases who were treated in our hospital from November 2009 to January 2013 were enrolled in the stdy,who were divided into experimental group(n=40)and control group(n=40).There were 2 cases of loss follow-up in experimental group,and there were 4 cases of loss follow-up in control group.The patients in experimental group were treated by CPAP combined with drug therapy,however the patients in control group were treated by drug therapy only.The incidence rates of cardiovascular and cerebrovascular events were observed and compared between the two groups.Results After 5-year follow-up,there were 9 cases of cardiovascular and cerebrovascular events including 8 case of nonfatal stroke,1 case of cardiovascular death in experimental group.However there were 17 cases of cardiovascular and cerebrovascular events including 12 cases of nonfatal stroke,1 case of fatal stroke,3 cases of nonfatal cardiovascular disease and 1 case of cardiovascular death in control group.The incidence rate of cardiovascular and cerebrovascular events in experimental group was significantly lower than that in control group(23.7%vs 47.2%,P<0.05).After CPAP treatment there were significant differences in blood pressure levels of patients at 12 months and 24 months after treatment,as compared with those at first visiting(P<0.05).Conclusion CPAP treatment can reduce the incidence of cardiovascular and cerebrovascular events to some extent in patients with OSAS complicated by cerebrovascular diseases,which can reduce the blood pressure of patients,therefor,which deserves clinical popularization.

关 键 词：阻塞性睡眠呼吸暂停综合征 持续气道正压通气 心脑血管事件 

分 类 号：R56[医药卫生—呼吸系统]