合并OSAHS对冠状动脉旁路移植术患者夜间血压及心绞痛的影响  

Influence of OSAHS on nocturnal blood pressure and angina pectoris in patients undergoing cardiac artery bypass graft

作　　者：何媛[1] 刘媛[1] 张俐鹏 张雅琼 许妍琦 陈秀梅[1] 李雪梅[1] He Yuan;Liu Yuan;Zhang Lipeng;Zhang Yaqiong;Xu Yanqi;Chen Xiumei;Li Xuemei(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华现代护理杂志》2020年第21期2853-2857,共5页Chinese Journal of Modern Nursing

摘　　要：目的探讨合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对冠状动脉旁路移植术(CABG)患者夜间血压和发生心绞痛的影响。方法采用目的抽样法选择2018年1—12月在首都医科大学附属北京安贞医院行单纯CABG的手术患者76例,术前行便携式睡眠呼吸监测(PG)及床旁血压监测。根据呼吸暂停指数(AHI)分为轻度或无OSAHS患者35例,中重度OSAHS患者41例,比较两组患者基线资料、睡眠呼吸检查指标、夜间心绞痛、夜间21∶00/凌晨3∶00/凌晨6∶00血压等指标的差异。结果合并中重度OSAHS的CABG患者凌晨3∶00收缩压为(115.8±12.5)mmHg、凌晨6∶00收缩压为(156.8±17.5)mmHg,均高于合并轻度或无OSAHS患者,差异有统计学意义(P<0.05)。合并中重度OSAHS的CABG患者发生夜间心绞痛率为29.27%(12/41),高于合并轻度或无OSAHS患者的2.86%(1/35),差异有统计学意义(P<0.05)。Logistic回归分析显示,患者凌晨3∶00收缩压可影响合并OSAHS的CABG患者夜间心绞痛的发生(OR=1.050,95%CI 1.003~1.100,P=0.039);平均氧饱和度下降可增加该类患者夜间心绞痛的发生(OR=0.628,95%CI 0.397~0.993,P=0.046)。结论合并OSAHS的CABG患者凌晨收缩压升高,且合并OSAHS会增加CABG患者夜间心绞痛的发生率。Objective To explore the influence of obstructive sleep apnea hypopnea syndrome(OSAHS)on nocturnal blood pressure and angina pectoris in patients undergoing cardiac artery bypass graft(CABG).Methods From January to December 2018,we selected 76 patients with simple CABG at Beijing Anzhen Hospital affiliated to Capital Medical University by purposive sampling.Before surgery,patients were treated with the portable sleep respiratory monitoring and bedside blood pressure monitoring.Patients were divided into group of mild or no OSAHS(n=35)and group of moderate or severe OSAHS(n=41)based on apnea hypopnea index(AHI).We compared the differences in the baseline data,sleep respiratory examination indexes,nocturnal angina pectoris,blood pressure at 21∶00,3∶00 and 6∶00 among patients between two groups.Results Among CABG patients with moderate or severe OSAHS,the systolic pressure at 3∶00 and 6∶00 was(115.8±12.5)mmHg and(156.8±17.5)mmHg respectively all higher than those among CABG patients with mild or no OSAHS with statistical differences(P<0.05);the incidence of nocturnal angina pectoris was 29.27%(12/41)higher than that[2.86%(1/35)]among CABG patients with mild or no OSAHS with a statistical difference(P<0.05).Logistic regression analysis showed that the systolic pressure at 3∶00 could affect the occurrence of nocturnal angina pectoris among CABG patients with OSAHS(OR=1.050,95%CI 1.003-1.100,P=0.039);the decrease of average oxygen saturation could also affect the occurrence of nocturnal angina pectoris among those patients(OR=0.628,95%CI 0.397-0.993,P=0.046);the differences were all statistical.Conclusions Early morning systolic pressure of CABG patients with OSAHS raises,and OSAHS may increase the incidence of nocturnal angina pectoris among CABG patients.

关 键 词：睡眠呼吸暂停综合征 冠状动脉旁路移植术 睡眠呼吸监测 血压 心绞痛 

分 类 号：R766[医药卫生—耳鼻咽喉科] R654.2[医药卫生—临床医学]