【作者】 林其昌； 丁海波； 王春娥； 黄鸿波； 陈公平； 师广斌； 陈华； 赵建铭；

【机构】 福建医科大学附一医院呼吸内科；

【摘要】 目的: 初步探讨经鼻持续气道正压通气(nasalContinuous Positive Airway Pressure nCPAP) 治疗阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea／hypopnea syndrome OSAHS)合并左室收缩功能不全患者的疗效和机制。方法: 21例OSAHS左室收缩功能不全患者随机分为2组,行PSG 检测、超声测量左室收缩末和舒张末内径、放射性核素心血池显影测量LVEF,并测定血浆内皮素(ET), 测量血压。一组在原药物治疗基础上用nCPAP治疗,另一组继续原药物治疗,3个月后观察上述指标变化。结果:经nCPAP治疗的左室收缩功能不全OSAHS患者整夜睡眠监测中呼吸暂停低通气指数(AHI)、最低脉搏血氧饱和度(SpO2Low)、平均呼吸暂停时间、一整夜睡眠监测中患者脉搏血氧饱和度低于90％时间占整个睡眠监测时间的百分比(％TST-SpO2<90％)、％TST-SpO2<80％均明显改善(P<0．01),血浆ET、夜间平均心率和平均收缩压较治疗前明显降低(P<0．05),左室收缩末内径较治疗前缩短(P<0．05)、左室射血分数提高(P<0．01)。结论:nCPAP治疗可以消除呼吸暂停、纠正低氧血症,明显降低血浆ET含量,降低夜间平均心率和平均收缩压,改善左室收缩功能。更多还原

【Abstract】 Objective To observe effects and mechanism of nCPAP in OSAHS patients with left ventricular systolic dysfunction. Methods The twenty-one OSAHS patients with left ventricular systolic dysfunction underwent overnight polysomnography、 echocardiography and gated radionuclide angiography, whose plasma endothelin were measured. The subjects were randomly assigned to receive pharmacologic therapy either alone (10 patients) or with the addition of continuous positive airway pressure (11 patients) for three months. The assessment protocol was then repeated. Results After three months’ nCPAP therapy in OSAHS with left ventricular systolic dysfunction, the AHI、 overnight minimum SpO2(%)、 Mean apnea duration、 %TST-SpO2<90% and %TST-SpO2<80% were significantly improved (P<0. 01), nocturnal mean heart rate and mean systolic blood pressure were significantly decreased, the left ventricular ejection fraction increased significantly (P<0.01) followed with left ventricular end-systolic dimension and plasma endothelin decrease(P<0.05). Conclusion nCPAP may abolish sleep apnea and hypopnea, correct the recurrent hypoxemia , obviously reduce the plasma endothelin level, reduce the nocturnal mean heart rate and reduce systolic blood pressure, obviously improve left ventricular systolic function.更多还原