【摘要】 目的观察风湿性心瓣膜病(RVHD)合并中枢性睡眠呼吸暂停(CSA)患者心瓣膜置换术后主观和客观睡眠质量变化情况及影响因素。方法选择262例拟行心瓣膜置换术的RVHD患者行多导睡眠监测筛查出CSA并记录基线信息,于2010年4月至2013年1月对合并CSA的21例患者进行术后第3、6及12个月的匹茨堡睡眠质量指数(PSQI)量表和Epworth嗜睡量表问卷调查,同时记录多导睡眠监测及心功能相关指标。结果手术后,患者的纽约心脏病协会分级持续下降[术前及术后3次随访结果分别为(3.7±0.5)、(2.3±0.6)、(1.7±0.6)、(1.6±0.7)分,F=81.124,P<0.05],左心室射血分数持续提高[分别为(58.5±6.8)%、(60.0±7.4)%、(60.9±5.6)%、(64.4±4.0)%,F=7.182,P<0.05],6分钟步行距离不断延长[分别为(271.5±76.6)、(422.1±71.9)、(445.1±56.2)、(454.5±63.5)m,F=67.134,P<0.05],睡眠呼吸暂停低通气指数[分别为(26.2±13.4)、(12.0±11.5)、(8.6±7.5)、(7.4±5.5)次/h,F=20.548,P<0.05]、中枢性睡眠呼吸暂停指数[分别为(19.6±10.3)、(0.5±1.5)、(0.3±1.3)、(0.2±0.7)次/h,F=72.926,P<0.05]和氧减指数[分别为(20.1±16.6)、(10.8±9.5)、(8.5±7.2)、(6.1±5.1)次/h,F=9.646,P<0.05]持续改善。觉醒指数总体呈现下降趋势[分别为(23.1±12.1)、(2.7±3.8)、(3.5±4.8)、(2.2±2.1)次/h,F=58.370,P<0.05]。患者PSQI评分不断降低[分别为(11.1±3.2)、(8.2±3.3)、(6.0±3.8)、(4.4±2.5)分,F=27.670,P<0.05]。Epworth嗜睡量表评分总体呈现减少趋势[分别为(13.3±5.7)、(6.9±4.5)、(8.2±4.8)、(6.1±3.7)分,F=15.994,P<0.05]。结论心瓣膜置换术可改善RVHD合并CSA患者的主观与客观睡眠质量,其改善趋势与术后心功能恢复一致。更多还原

【Abstract】 Objective To observes^the postoperative transformation of subjective and objective sleep quality and related influencing factors in patients with rheumatic valvular heart disease（RVHD） who were found with central sleep apnea（CSA） after cardiac valve replacement. Methods A total of 262 patients undergoing cardiac valve replacement were screened for CSA by overnight polysomnography and 21 patients with CSA were enrolled and followed up successfully in^the 3^th, 6^th and 12^th month of postoperation from April 2010 to January 2013. The Pittsburgh Sleep Quality Index, Epworth Sleepiness, polysomnography and cardiac function were evaluated in preoperation and postoperation(in^the 3^th, 6^th and 12^th month). Results New York Heart Association class [preoperation and postoperation:（3.7±0.5）,（2.3±0.6）,（1.7±0.6）,（1.6±0.7）, F=81.124, P<0.05] continuously decreased, left ventricular ejection fraction[preoperation and postoperation:（58.5±6.8）%,（60.0±7.4）%,（60.9±5.6）%,（64.4±4.0）%, F=7.182, P<0.05] steadily increased, six-minute walk distance [preoperation and postoperation:（271.5±76.6）,（422.1±71.9）,（445.1±56.2）,（454.5±63.5） m, F=67.134, P<0.05] constantly increased. During postoperative follow-up, sleep apnea-hypopnea index[preoperation and postoperation:（26.2±13.4）,（12.0±11.5）,（8.6±7.5）,（7.4±5.5）/h, F=20.548, P<0.05, central sleep apnea index [preoperation and postoperation:（19.6±10.3）,（0.5±1.5）,（0.3±1.3）,（0.2±0.7）/h, F=72.926, P<0.05] and oxygen desaturation index [preoperation and postoperation:（20.1±16.6）,（10.8±9.5）,（8.5±7.2）,（6.1±5.1）/h, F=9.646, P<0.05]sustained improved. Aroual index [preoperation and postoperation:（23.1±12.1）,（2.7±3.8）,（3.5±4.8）,（2.2±2.1）/h,F=58.370, P<0.05] presented overall downward trend. Pittsburgh Sleep Quality Index scale [preoperation and postoperation:（11.1±3.2）,（8.2±3.3）,（6.0±3.8）,（4.4±2.5）, F=27.670, P<0.05] were constantly improved. Epworth Sleepiness scale [preoperation and postoperation:（13.3±5.7）,（6.9±4.5）,（8.2±4.8）,（6.1±3.7）, F=15.994, P<0.05] showed overall reduction. Conclusion The sleep quality of patients with RVHD and CSA is improved after cardiac valve replacement, of which^the trend is in keep with postoperative recovery of cardiac function.更多还原