无创正压通气对睡眠呼吸暂停综合征合并心血管疾病患者的影响

发布时间：2018-03-23 10:27

本文选题：睡眠呼吸暂停综合征　切入点：心血管疾病　出处：《郑州大学》2013年硕士论文

【摘要】：目的了解睡眠呼吸暂停综合征(Sleep Apnea Syndrome,SAS)合并心血管疾病(包括高血压、冠心病、心律失常、心力衰竭等)患者在常规应用心血管药物治疗基础上使用无创正压通气(non-invasive positive pressure ventilation, NPPV)治疗的效果,为此类患者规范治疗方案的制定提供依据。试验方法选择心内科门诊及住院的心血管疾病患者,经多导联睡眠监测(polysomnography,PSG)确诊为中、重SAS者作为研究对象,共135例,其中高血压76例,高血压性心脏病25例,冠心病81例,冠心病心肌梗死39例,风湿性心脏病29例,扩张性心肌病31例,心律失常140例,心力衰竭40例。按照随机方法分为NPPV组(108例)和对照组(109例),对照组单纯行心内科常规药物治疗,NPPV组在常规药物治疗基础上加用NPPV,治疗3个月后复查试验前检测内容,并比较治疗前后变化。结果 1.NPPV组治疗前后比较及与对照组比较,Epworth嗜睡评分(Epworth Sleepiness Scale, ESS)、体重指数(Body mass index,BMI)、呼吸暂停低通气指数(Apnea Hyponea Index, AHI)、氧减指数(oxygen desaturation index,ODI)、微觉醒指数均降低(P0.01或P0.05),Ⅲ期及快动眼(Rapid eye move, REM)期睡眠时间明显增加、最低血氧饱和度(the lowest pulse oxygen saturation,L-SpO2)升高(P均0.01)；对照组治疗前后比较差异无统计学意义(P均0.05)。2.治疗后两组血压均较治疗前下降,NPPV组较对照组血压下降幅度大,除对照组夜间平均舒张压(night-mean diastolic blood pressure,n-MDBP)与治疗前比较差异无统计学意义外(P0.05), NPPV组与对照组治疗前后比较、治疗后NPPV组与对照组比较,血压变化均有统计学意义(P0.05)；NPPV组“非杓型”血压节律所占比例下降,与治疗前比较及与对照组比较差异均有统计学意义(P0.01)。NPPV组患者中有9例停用降压药,仅NPPV治疗便可使血压维持在正常范围,占NPPV治疗人数的25.7%,对照组均需持续服用降压药控制血压；NPPV组使用一种以上降压药的人数由13例(37.4%)减为8例(22.9%),对照组使用一种以上降压药的人数无改变,且有3例患者需在原来基础上加用一种降压药。3.治疗后两组比较,NPPV组各种心律失常发生率、无症状缺血性ST-T改变发生率及最快、最慢心率的变化范围均显著减少(P0.01或P0.05),陈-施呼吸(cheyne-stokes respiration, CSR)发生率下降6.4%; NPPV组较对照组夜间各种心律失常发生的总次数明显减少(P均0.01)、心率变异性(Heart rate variability,HRV)各指标均升高(P0.01)；夜间心律失常总次数与AHI呈正相关,与L-SPO2呈负相关(P均0.01)。4.40例心衰患者治疗后两组比较,NPPV组左室射血分数(Left ventricular ejection fraction,LVEF)、6分钟步行距离均明显升高(P均0.01),血B型脑钠肽(B-type natriuretic peptide, BNP)明显下降(P0.01),美国心脏病学会(New York Heart Association,NYHN)心功能分级改善(P0.01)。结论对SAS合并心血管疾病患者,在常规应用心血管药物治疗基础上加用NPPV治疗能显著提高疗效,其效果明显优于单纯药物治疗。
[Abstract]:objective
Understanding of sleep apnea syndrome (Sleep Apnea, Syndrome, SAS) with cardiovascular diseases (including hypertension, coronary heart disease, arrhythmia, heart failure and other cardiovascular drugs) patients in the conventional treatment on the basis of application of noninvasive positive pressure ventilation (non-invasive positive pressure ventilation, NPPV) treatment effect, provide the basis for the development of standardized treatment of such patients.
test method
Department of cardiology outpatient and hospitalization in patients with cardiovascular disease, by polysomnography monitoring (polysomnography, PSG) were diagnosed as severe SAS, as the research object, a total of 135 cases, including 76 cases of hypertension, 25 cases of hypertensive heart disease, 81 cases of coronary heart disease, 39 cases of myocardial infarction, coronary heart disease, 29 cases of rheumatic heart disease. 31 cases of dilated cardiomyopathy, 140 cases of arrhythmia, heart failure in 40 cases. Randomly divided into NPPV group (108 cases) and control group (109 cases), the control group only underwent Department of Cardiology routine drug treatment, NPPV group in the conventional drug treatment combined with NPPV treatment, follow-up test after 3 months before the examination the content, and compared before and after the treatment.
Result
1.NPPV group before and after treatment and compared with the control group, Epworth sleepiness score (Epworth Sleepiness Scale, ESS), body mass index (Body mass, index, BMI), apnea hypopnea index (Apnea Hyponea, Index, AHI), oxygen desaturation index (oxygen desaturation, index, ODI), arousal index were lower (P0.01 or P0.05), stage III and REM (Rapid eye move, REM) increased significantly during sleep time, the lowest oxygen saturation (the lowest pulse oxygen saturation, L-SpO2) increased (P 0.01); the control group before and after treatment there was no significant difference (P 0.05).2. after treatment the blood pressure of the two groups were compared with those before treatment decreased NPPV group than in the control group, blood pressure decreased greatly, in addition to the control group mean diastolic blood pressure (night-mean diastolic night blood pressure, n-MDBP) compared with before treatment, the differences were not statistically significant (P0.05), NPPV group and control group before and after treatment, after treatment of N Compared PPV group and control group, the blood pressure changes were statistically significant (P0.05); NPPV group of non dipper type blood pressure rhythm proportion decreased, and compared with before treatment and the control group had significant difference (P0.01) of 9 cases of discontinuation of antihypertensive drugs in group.NPPV patients, only NPPV treatment can make blood pressure remained in the normal range, accounting for 25.7% of the number of NPPV treatment, the control group is required to continue taking antihypertensive drugs to control blood pressure; the number of NPPV group uses one or more antihypertensive drugs from 13 cases (37.4%) reduced to 8 cases (22.9%), the control group uses one or more antihypertensive drugs the number of people who had no change, and 3 patients in the original based on the use of an antihypertensive drug.3. compared the two groups after treatment, the incidence of arrhythmia in NPPV group, the incidence of asymptomatic ischemic ST-T changes and changes in the scope of the fastest, lowest heart rates were significantly decreased (P0.01 or P0.05), Cheyne Stokes respiration (Cheyne-Stokes resp Iration, CSR) decreased the incidence of 6.4%; NPPV group than in the control group, the total number of all kinds of nocturnal arrhythmia decreased significantly (P 0.01), heart rate variability (Heart rate, variability, HRV) of each index were increased (P0.01); the total number of arrhythmia at night with AHI Cheng Zhengxiang, was negatively correlated with L-SPO2 (P 0.01) for the treatment of.4.40 patients with heart failure after the two groups, NPPV group, left ventricular ejection fraction (Left ventricular ejection fraction, LVEF), 6 minutes walking distance were significantly increased (P 0.01), B blood type brain natriuretic peptide (B-type natriuretic, peptide, BNP) were significantly decreased (P0.01), the American society heart disease (New York Heart Association, NYHN) improvement in heart function (P0.01).
conclusion
For patients with SAS combined with cardiovascular disease, NPPV treatment based on routine cardiovascular drugs can significantly improve the curative effect, and its effect is obviously better than that of simple drug therapy.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R766;R54

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