持续气道正压通气治疗阻塞性睡眠呼吸暂停低通气综合征合并冠心病的预后研究  

Effect of continuous positive airway pressure ventilation on long-term prognosis of OSAHS complicated with coronary heart disease

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 Peilin;SU Xiaoyan;GUO Bin;LIU Yu(Department of Sleep Medicine Center,Gansu Provincial Hospital,Lanzhou 730000,China;Department of Day Care Center,Gansu Provincial Hospital Lanzhou 730000,China)

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,兰州730000

出　　处：《国际耳鼻咽喉头颈外科杂志》2021年第5期249-253,共5页International Journal of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金(82160267、61962034);2019年甘肃省卫生行业科研计划项目(GSWSKY-2019-88);2018年甘肃省人民医院院内基金项目(18GSSY4-19)。

摘　　要：目的探讨持续气道正压通气(CPAP)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并冠状动脉性心脏病(coronary heart disease,CHD)长期预后影响的研究。方法随机选取2019年1月1日至2020年1月31日在甘肃省人民医院睡眠中心收治的OSAHS合并CHD患者120例,依据睡眠呼吸暂停低通气指数(AHI)分为:A组(轻、中度OSAHS合并CHD)60例和B组(重度OSAHS组合并CHD)60例。对比分析两组血清指标、量表、多道睡眠监测(PSG)及冠脉造影结果。截至2021年2月1日治疗≥12个月,分别对A、B组中的常规治疗组以及持续气道正压通气(CPAP)组的血清指标、量表、PSG、冠脉造影结果及不良心血管事件再次进行比较。结果治疗前B组患者AHI、体质量指数(BMI)、吸烟、高血压及2型糖尿病人数;总胆固醇(TG)、甘油三脂(TC)、低密度脂蛋白(LDL)、同型半胱氨酸(HCY);Epworth嗜睡量表(Epworth sleepiness scale,ESS)、汉密顿抑郁量表(Hamilton depression scale,HAMD)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分;多血管病变、TIMI 0-1级及冠脉病变SYNTAX评分均高于较A组,差异有统计学意义。治疗≥12个月后,A组+CPAP组较常规治疗组,AHI及ESS评分降低,最低动脉血氧饱和度(lowest arterial oxygen saturation,LSaO_(2))增加(P<0.05);HAMA评分、HAMD评分、血清指标、TIMI及SYNTAX评分及不良心血管事件的发生两组间比较无统计学意义(P均>0.05)。B组+CPAP组较常规治疗组,ESS、HAMA、HAMD评分、AHI降低,LSaO_(2)增加,TG、TC及HCY降低,TIMI 0-2级及SYNTAX评分高于A组(P<0.05),各种不良心血管事件的发生显著降低。结论重度较轻中度OSAHS合并CHD患者冠脉病变程度重,CPAP治疗有利于重度OSAHS合并CHD的长期预后。Objective To investigate the effects of CPAP for OSAHS combined coronary heart disease(CHD)long-term prognosis.Methods We randomly selected 120 cases OSAHS combind CHD,from 2019.1-2019.12 in Gansu Provinceial Hospital Sleep Center,according to apnea hypopnea index(AHI)were divided into two groups,group A(light,medium OSAHS and CHD)60 cases,group B(severe OSAHS and CHD)60 cases.The serum indexes,scale,PSG and coronary angiography results of the two groups were compared and analyzed.After>12 months of treatment(as of February 1,2021),the serum indexes,scales,polysomnography(PSG),coronary angiography and adverse cardiovascular events of the routine treatment and the+CPAP treatment group in group A and B were compared again.Results Before treatment,the scores of AHI,BMI,smoking,hypertension and type 2 diabetes,TG,TC,LDL,HCY,ESS and Hamilton anxiety and depression,polyangiopathy,TIMIO-2 grade and SYNTAX score in group B were higher than group A,and the differences were statistically significant(P<0.01).After 12 months of treatment,+CPAP treatment group showed lower AHI and ESS scores and increased LSaO:than routine treatment group(P<0.05).There were no statistically significant differences in anxiety score,depression score,serum indicators,TIMI and SYNTAX score and the incidence of adverse cardiovascular events between the two groups(P>0.05).In group B,compared with the group treated with conventional treatment alone,the ESS,anxiety and depression scores,AHI and LSaO_(2) scores,TG,TC and HCY scores,TIMI0-1 grade and SYNTAX scores were higher than those of group A(P<0.05),and the incidence of various adverse cardiovascular events was significantly reduced.Conclusions Severe OSAHS patients with CHD had more severe coronary lesions than those with mild to moderate OSAHS.In patients with severe OSAHS combined with CHD;CPAP treatment is beneficial to the long-term prognosis of severe OSAHS with CHD.

关 键 词：睡眠呼吸暂停 阻塞性 连续气道正压通气 预后 治疗结果 冠心病 

分 类 号：R766[医药卫生—耳鼻咽喉科] R541.4[医药卫生—临床医学]