本文選題：睡眠呼吸暫停綜合征　切入點(diǎn)：心血管疾病　出處：《鄭州大學(xué)》2013年碩士論文

【摘要】：目的 了解睡眠呼吸暫停綜合征(Sleep Apnea Syndrome,SAS)合并心血管疾病(包括高血壓、冠心病、心律失常、心力衰竭等)患者在常規(guī)應(yīng)用心血管藥物治療基礎(chǔ)上使用無創(chuàng)正壓通氣(non-invasive positive pressure ventilation, NPPV)治療的效果,為此類患者規(guī)范治療方案的制定提供依據(jù)。 試驗(yàn)方法 選擇心內(nèi)科門診及住院的心血管疾病患者,經(jīng)多導(dǎo)聯(lián)睡眠監(jiān)測(cè)(polysomnography,PSG)確診為中、重SAS者作為研究對(duì)象,共135例,其中高血壓76例,高血壓性心臟病25例,冠心病81例,冠心病心肌梗死39例,風(fēng)濕性心臟病29例,擴(kuò)張性心肌病31例,心律失常140例,心力衰竭40例。按照隨機(jī)方法分為NPPV組(108例)和對(duì)照組(109例),對(duì)照組單純行心內(nèi)科常規(guī)藥物治療,NPPV組在常規(guī)藥物治療基礎(chǔ)上加用NPPV,治療3個(gè)月后復(fù)查試驗(yàn)前檢測(cè)內(nèi)容,并比較治療前后變化。 結(jié)果 1.NPPV組治療前后比較及與對(duì)照組比較,Epworth嗜睡評(píng)分(Epworth Sleepiness Scale, ESS)、體重指數(shù)(Body mass index,BMI)、呼吸暫停低通氣指數(shù)(Apnea Hyponea Index, AHI)、氧減指數(shù)(oxygen desaturation index,ODI)、微覺醒指數(shù)均降低(P0.01或P0.05),Ⅲ期及快動(dòng)眼(Rapid eye move, REM)期睡眠時(shí)間明顯增加、最低血氧飽和度(the lowest pulse oxygen saturation,L-SpO2)升高(P均0.01)；對(duì)照組治療前后比較差異無統(tǒng)計(jì)學(xué)意義(P均0.05)。2.治療后兩組血壓均較治療前下降,NPPV組較對(duì)照組血壓下降幅度大,除對(duì)照組夜間平均舒張壓(night-mean diastolic blood pressure,n-MDBP)與治療前比較差異無統(tǒng)計(jì)學(xué)意義外(P0.05), NPPV組與對(duì)照組治療前后比較、治療后NPPV組與對(duì)照組比較,血壓變化均有統(tǒng)計(jì)學(xué)意義(P0.05)；NPPV組“非杓型”血壓節(jié)律所占比例下降,與治療前比較及與對(duì)照組比較差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。NPPV組患者中有9例停用降壓藥,僅NPPV治療便可使血壓維持在正常范圍,占NPPV治療人數(shù)的25.7%,對(duì)照組均需持續(xù)服用降壓藥控制血壓；NPPV組使用一種以上降壓藥的人數(shù)由13例(37.4%)減為8例(22.9%),對(duì)照組使用一種以上降壓藥的人數(shù)無改變,且有3例患者需在原來基礎(chǔ)上加用一種降壓藥。3.治療后兩組比較,NPPV組各種心律失常發(fā)生率、無癥狀缺血性ST-T改變發(fā)生率及最快、最慢心率的變化范圍均顯著減少(P0.01或P0.05),陳-施呼吸(cheyne-stokes respiration, CSR)發(fā)生率下降6.4%; NPPV組較對(duì)照組夜間各種心律失常發(fā)生的總次數(shù)明顯減少(P均0.01)、心率變異性(Heart rate variability,HRV)各指標(biāo)均升高(P0.01)；夜間心律失�？偞螖�(shù)與AHI呈正相關(guān),與L-SPO2呈負(fù)相關(guān)(P均0.01)。4.40例心衰患者治療后兩組比較,NPPV組左室射血分?jǐn)?shù)(Left ventricular ejection fraction,LVEF)、6分鐘步行距離均明顯升高(P均0.01),血B型腦鈉肽(B-type natriuretic peptide, BNP)明顯下降(P0.01),美國心臟病學(xué)會(huì)(New York Heart Association,NYHN)心功能分級(jí)改善(P0.01)。 結(jié)論 對(duì)SAS合并心血管疾病患者,在常規(guī)應(yīng)用心血管藥物治療基礎(chǔ)上加用NPPV治療能顯著提高療效,其效果明顯優(yōu)于單純藥物治療。
[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.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R766;R54

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