持续气道正压通气与肾动脉去交感神经射频消融对高血压合并阻塞性睡眠呼吸暂停综合征的疗效比较

发布时间：2018-02-03 11:52

本文关键词： 睡眠呼吸暂停阻塞性连续气道正压通气交感神经切除术高血压　出处：《南京医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：分析高血压合并中重度阻塞性睡眠呼吸暂停综合征(Obstructive Sleep Apnea Syndrome,OSAS)患者接受持续气道正压通气(continuous positive airway pressure,CPAP)和肾动脉去交感神经射频消融(renal artery sympathetic denervation,RSD)治疗效果的差异。方法：回顾性分析2011年10月至2012年9月南京医科大学第一附属医院诊治的31例高血压合并中重度OSAS患者的临床资料,其中接受CPAP治疗16例(CPAP组)、RSD治疗15例(RSD组),比较两组患者治疗前及治疗30d时的多导睡眠监测参数及24 h动态血压状况。结果：治疗前两组患者性别构成比、年龄、体重指数(Body Mass Index,BMI)和夜间呼吸暂停低通气指数(Apnea Hypoventilation Index,AHI)、平均脉氧饱和度(SpO2)和最低SP02等指标差异无统计学意义。与治疗前比较,CPAP组治疗30天时夜间AHI显著降低(5±3 Vs 35±12,P0.05)且平均Sp02和最低Sp02均显著增高(95.6%±1.4%vs 93.6%±1.7%,89.2%±2.7% vs 79.1%±4.0%,均P0.05)；RSD组术后30天夜间呼吸暂停低通气指数(AHI)降低(27±14 vs 32±12,P0.05),平均Sp02增高(94.3%±2.2% vs 93.9%±2.0%,P0.05),但最低Sp02变化不明显(80.1%±6.2% vs 79.5%±4.7%,P0.05)。与RSD组相比,治疗30天时,CPAP组AHI更低(P=0.000)且平均Sp02与最低Sp02更高(均P0.05)。治疗30天时CPAP组和RSD组平均收缩压、平均舒张压分别为(130±12)、(83±7)mmHg(1 mmHg=0.133 kPa)和(122±9)、(80±8) mmHg,均低于治疗前的(136±14)、(87±7)mmHg和(134±20)、(88± 14)mmHg(均P0.05),且RSD组平均收缩压降低较CPAP组更明显(P0.05)。结论：CPAP与RSD均可不同程度地改善合并高血压的中重度OSAS患者的睡眠呼吸参数和血压,但CPAP对夜间AHI、SpO2的改善更显著,而RSD对改善收缩压更显著。
[Abstract]:Objective: to analyze the obstructive Sleep Apnea Syndrome of hypertension complicated with moderate and severe obstructive sleep apnea syndrome. OSAS) patients received continuous positive airway pressure ventilation and continuous positive airway pressure. CPAP) and renal artery sympathetic denervation in renal artery radiofrequency ablation (RFA). RSD). Methods: the clinical data of 31 patients with hypertension complicated with moderate and severe OSAS from October 2011 to September 2012 in the first affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Among them, 16 cases were treated with CPAP and 15 cases were treated with CPAP. The parameters of polysomnography and 24 h ambulatory blood pressure were compared between the two groups before treatment and 30 days after treatment. Results: before treatment, the sex composition ratio and age of the patients in the two groups were compared. Body Mass index (BMI) and nocturnal apnea Hypoventilation Index (nocturnal apnea hypopnea index). There was no significant difference in AHIH, mean pulse oxygen saturation (SPO _ 2) and minimum SP02 between before treatment and before treatment. After 30 days of treatment, AHI in CPAP group was significantly decreased by 5 卤3 Vs 卤12. P0.05) and the average Sp02 and minimum Sp02 were significantly increased by 95.6% 卤1.4 vs 93.6% 卤1.7%. 89.2% 卤2.7% vs 79.1% 卤4.0; In RSD group, the nocturnal apnea hypopnea index (AHI) was decreased by 27 卤14 vs 32 卤12 P0.05 at 30 days after operation. The average Sp02 increased by 94.3% 卤2.2% vs 93.9% 卤2.0p 0.05). But the change of minimum Sp02 was not obvious (80.1% 卤6.2% vs 79.5% 卤4.7). Compared with RSD group, it was 30 days after treatment. The AHI of CPAP group was lower than that of Sp02 0.000) and the average Sp02 was higher than that of the lowest Sp02 (P0.050.The mean systolic blood pressure of CPAP group and RSD group was 30 days after treatment. The mean diastolic blood pressure (DBP) was 130 卤12 mmHg=0.133 / KPA (83 卤7mm) and 80 卤8 mmHg (P < 0.05), respectively. It was significantly lower than that before treatment (P 0.05). It was significantly lower than that before treatment (87 卤7 mm Hg and 134 卤20 mm Hg vs 88 卤14 mm Hg, P 0.05). The mean systolic blood pressure in RSD group was significantly lower than that in CPAP group (P0.05). Conclusion both RSD and CPAP can improve sleep breathing parameters and blood pressure in moderate and severe OSAS patients with hypertension to some extent. However, CPAP improved nocturnal AHI SpO2 more significantly, while RSD improved systolic blood pressure more significantly.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R766;R544.1

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