阻塞性睡眠呼吸暂停对慢性阻塞性肺疾病患者左心结构和功能的影响  

Effects of obstructive sleep apnea on left heart structure and function i n patients with chronic obstructive pulmonary disease

作　　者：程秋菊 秦勇 谢于鹏[2] CHENG Qiuju;XIE Yupeng(Department of Respiratory and Critical Care Medicine,The First Peopl e’s Hospital of Aksu Prefecture,Aksu 843000,Xinjiang,China;Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Wenzhou Medical University,W enzhou 325000,China)

机构地区：[1]阿克苏地区第一人民医院呼吸与危重症医学科,新疆阿克苏843000 [2]温州医科大学附属第一医院呼吸与危重症医学科,浙江温州325000

出　　处：《当代医药论丛》2023年第16期32-32,共1页

基　　金：浙江省教育厅资助项目,项目编号:Y202044600。

摘　　要：目的:探讨阻塞性睡眠呼吸暂停(OSA)对慢性阻塞性肺疾病(慢阻肺)患者左心结构和功能的影响。方法:选取就诊于阿克苏地区第一人民医院的慢阻肺缓解期患者98例为研究对象。根据肺功能检查和多导睡眠监测结果,将患者分为单纯慢阻肺组、单纯OSA组和重叠综合征(OS)组。比较三组的心脏超声各项指标,分析睡眠呼吸暂停指数(AHI)、最低血氧饱和度(LSpO_(2))与心脏超声各项指标的关系。结果:各组年龄、血压和体质指数(BMI)匹配。OS组和单纯OSA组的左室舒张末期内径(LVEDD)显著高于单纯慢阻肺组,OS组的左室舒张末期容积(LVEDV)、左室收缩末期内径(LVESD)均与单纯慢阻肺组有显著性差异;单纯OSA组和OS组的二尖瓣口舒张早期血流速度/舒张晚期血流速度(E/A)均<1,且OS组的E/A较单纯慢阻肺组减小,差异有统计学意义(P<0.05);OS组的右心室内径(RVID)和右室流出道内径(RVOT)均较单纯慢阻肺组显著增加。AHI和LSpO_(2)与LVEDD、LVEDV呈正相关,与E/A呈负相关。结论:OSA及间歇低氧可能与慢阻肺患者的左心变化有关,提示OSA可使慢阻肺患者的左心结构和功能恶化。Objective:To investigate the effects of obstructive sleep apnea(OSA)on left heart structure and function in patients with chronic obstructive pulmonary disease(COPD).Methods:98 patients with COPD in remission period were selected as the study objects.According to the results of pulmonary function examination and polysomnosis monitoring,the patients were divided into simple COPD group,simple OSA group and overlap syndrome(OS)group.The relationship between sleep apnea index(AHI),minimum oxygen saturation(LSpO_(2))and cardiac echocardiography indexes of the three groups was analyzed.Results:Age,blood pressure and body mass index(BMI)were matched in all groups.Left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic diameter(LVESD)in OS group and OSA group were significantly higher than those in COPD group alone.The early diastolic blood flow velocity/late diastolic blood flow velocity(E/A)of the mitral valve orifice were all<1 in the three groups,and the E/A of the OS group was lower than that of the simple COPD group,with statistical significance(P<0.05).The right ventricular diameter(RVID)and right ventricular outflow tract diameter(RVOT)in OS group and OSA group were significantly increased compared with COPD group alone.AHI and LSpO 2 were positively correlated with LVEDD and LVEDV,and negatively correlated with E/A.Conclusion:OSA and intermittent hypoxia may be related to left heart changes in COPD patients,suggesting that OSA can worsen left heart structure and function in COPD patients.

关 键 词：阻塞性睡眠呼吸暂停 慢性阻塞性肺疾病 左心结构 功能 

分 类 号：R562.2[医药卫生—呼吸系统]